A Controversial Proposal

No More Antibiotics for Acne!

Muneeza Muhammad, BA; Ted Rosen, MD


Skin Therapy Letter. 2013;18(5) 

In This Article

Parties Responsible for Antibiotic Resistance

There are four main contributors to the development of bacterial antibiotic resistance: the pharmaceutical industry, the agriculture and animal husbandry industry, patients, and healthcare providers. Due to the rise in antibiotic resistance, new drugs must be developed to treat highly virulent pathogens; however, the number of new antibacterials receiving US FDA approval has dramatically decreased. There has been a staggering 75% decrease in systemic antibacterial drugs approved by the FDA from 1983 to 2007.2 In part, the astounding cost of new drug development inhibits pharmaceutical industry investment. The cost to develop one systemic drug can range anywhere between $3.7-$11.8 billion dollars, including years of basic research, preclinical development, and clinical trials.[10] The significant decrease in novel antibiotic introduction parallels a considerable decrease in anti-infective drug discovery and development. Of the 13 pharmaceutical leaders in the world, only 5 have antibacterial discovery programs and the number of antibacterials in Phase 2 or 3 development is distressingly low.[2]

The agriculture and animal husbandry industry routinely use prophylactic antibiotics in livestock and fruit. Use of antibacterial compounds in these settings leads to constant selective pressure toward survival of resistant strains and contributes to a larger global resistance reservoir.[11]

Patients and healthcare providers also contribute to the problem. Patients, who often save unused antibiotics, share these agents with friends, relatives, neighbors and co-workers, or inappropriately use them - serve to expand the microbial resistance reservoir. It is not uncommon for healthcare providers to prescribe antibiotics when they are not indicated, use the wrong dose or duration for treatment, and frequently treat chronic conditions with antibiotics for extended periods of time. All of these practices can increase the risk of resistant organisms.

In dermatology, acne and rosacea are the two major conditions for which antibiotics are regularly used. Especially in the treatment of acne and rosacea, antibiotics are frequently prescribed for prolonged periods of time, often greater than 6 months. However, many non-infectious conditions, such as Hailey-Hailey disease, pityriasis lichenoides et varioliformis acuta (PLEVA), pityriasis rosea, pityriasis lichenoides chronica, hidradenitis suppurativa, and Gougerot-Carteaud syndrome are also treated with antibiotics. Although there are admittedly many contributing factors, dermatologists can control the part they play in propagating antimicrobial resistance.