A Controversial Proposal

No More Antibiotics for Acne!

Muneeza Muhammad, BA; Ted Rosen, MD


Skin Therapy Letter. 2013;18(5) 

In This Article

The Reality of Antibiotic Resistance and Rise of Superbugs

Numerous recent reports document an ever increasing number of infections which have become difficult or impossible to treat due to antibiotic resistance. The notorious and well-known story of methicillin-resistant Staphylococcus aureus (MRSA) is one example. Although MRSA primarily causes skin and soft tissue infections, particularly furuncles, it is also capable of causing life-threatening illnesses such as pneumonia, meningitis, osteomyelitis, endocarditis, and toxic shock syndrome.[1] Many of the first-line oral treatments for community-acquired MRSA (clindamycin, trimethoprim-sulfamethoxazole, and doxycycline) are commonly prescribed as long-term therapy for acne vulgaris.[1] Thus, treating acne with such antibiotics can theoretically induce staphylococcal resistance against these first-line drugs[1]— jeopardizing the health of both patients and the community at large.

Despite its prevalence and clear applicability to dermatology, MRSA is not the only pathogen of concern. The cleverly coined "ESKAPE" pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) currently cause the majority of hospital infections in the US and often "escape" antibiotic treatment.[2] Vancomycin-resistant Enterococcus, MRSA, carbapenem-resistant Klebsiella, multi-drug resistant (MDR) Acinetobacter, MDR Pseudomonas, and extended spectrum β-lactamase-producing Enterobacter are emerging as significant pathogens around the world.[2] With limited therapeutic options, mortality from these organisms is rising. Cases of sepsis and death secondary to Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella or that of Mariana Bridi da Costa, the Brazilian model who made headlines after suffering multiple amputations and eventually dying from urosepsis secondary to MDR Pseudomonas, exemplify the truly virulent nature of these organisms.[3–5] Aside from the ESKAPE microbes, resistant strains of tuberculosis (TB), gonorrhea, and the plague have emerged. Reports of total drug-resistant TB in India are distressing. Patients often seek treatment from private doctors who inappropriately prescribe antibiotics that serve to only amplify resistance and risk converting MDR-TB to total drug- or extended drug-resistant TB.[6] Expanded-spectrum cephalosporin-resistant Neisseria gonorrhea H041 and F89 strains isolated in Japan and France, respectively, may soon become a worldwide superbug responsible for truly untreatable gonorrhea.[7,8] The plasmid IP1202 in MDR Yersinia pestis gives it high-level resistance to streptomycin, tetracycline, chloramphenicol and sulfonamides—drugs recommended for plague prophylaxis and therapy.[9] These various superbugs, and others, constitute a significant public health and biodefense threat which, in part, stems from indiscriminate, inappropriate, irrational and profligate use of antibiotics. Any healthcare provider who doubts the global threat posed by emerging trends toward antibiotic resistance should review the data compiled and literature produced by the World Health Organization in conjunction with World Health Day 2011, available at: https://www.who.int/world-health-day/2011/en/index.html