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Acne vulgaris: A review of antibiotic therapy
Expert Opinion on Pharmacotherapy
Abstract
Antibiotic therapy has been integral to the management of inflammatory acne vulgaris for many years. Systemic antibiotics work via antibacterial, anti-inflammatory and immunomodulatory modes of action, and have been found to be useful in managing moderate-to-severe acne. Commonly prescribed antibiotics include tetracyclines, erythromycin and trimethoprim, with or without sulfamethoxazole. In selecting the appropriate antibiotic for patients needing to receive topical or systemic antibiotic therapy, the clinician should take into account the severity of the acne, cost-effectiveness, the safety profile of the drug and the potential for development of resistance. The widespread and long-term use of antibiotics over the years has unfortunately led to the emergence of resistant bacteria. The global increase in the antibiotic resistance of Propionibacterium acnes may be a significant contributing factor in treatment failures. It is therefore essential that clinicians prescribing antibiotics for the treatment of acne adopt strategies to minimise further development of bacterial resistance. This includes addressing compliance issues, using combination therapies, avoiding prolonged antibiotic treatment, and avoiding concomitant topical and oral antibiotics with chemically dissimilar antibiotics.
... Carbetocin has prolonged duration of action (approximately 1 hour) which ensures more contraction time and less adverse effect 18,19 .The clinical and pharmacological properties of carbetocin are similar to those of naturally occurring oxytocin.Carbetocin binds to oxytocin receptors present on the smooth musculature of the uterus, resulting in rhythmic contractions of the uterus, increased frequency of existing contractions and increased uterine tone 14 .A single dose of carbetocin has been hypothesis to act upto 16 hours in comparison to intravenous oxytocin infusion regarding the increase in uterine tone and the reduction of the risk of PPH in vaginal delivery 13 .Moreover, carbetocin ensures more effective contraction and less adverse effect like headache, tremor, hypotension, nausea, abdominal pain, and pruritus 14 . Several data of literature suggest that prophylactic administration of carbetocin may be a good alternative to oxytocin to prevent post-partum hemorrhage 20 . ...
... Mean age of study population were 23.9 ± 3.2 in carbetocin group and 23.3 ±3.2 in oxytocin group (Table I). Among the study patients 36.1% (17) had mild anemia in Carbetocin group and 42.6% (20) had mild anemia in oxytocin group. Mean systolic BP of patients were 112±5.6 mm of Hg and Diastolic BP were 75 ±4.3 ...
... In other study it was found 17% and 14.53% respectively 23 .In our study, among the hypertensive patients, maximum (62.7%) were urban and sub-urban dwellers. Nazir A, et al found that prevalence of hypertension more (21.6%) in urban areas 20 . In our study, most of the hypertensive (59.5%) had monthly income more than 5000 taka. ...
Background: Every day more than 220 women around the world die from severe bleeding after childbirth. Globally post-partum hemorrhage is the number one direct cause of maternal mortality. Most postpartum hemorrhages are caused by uterine atony and occur in the immediate postpartum period. Most of these tragic deaths can be prevented by active management of third stage of labour. Active management of the third stage of labor should be practiced routinely to decrease the risk of postpartum hemorrhage. Oxytocin is used for enhancing uterine contraction after delivery. But oxytocin has some limitations like shorter half- life, less contraction time and more side effects, whereas carbetocin has prolonged duration of action which ensures more contraction time and less adverse effects. This study was done to see the efficacy and safety of carbetocin over oxytocin for prevention of PPH after vaginal delivery. Methodology: A randomized controlled clinical trial was conducted in the Department of Obstetrics and Gynecology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh over a period of 9 months from January 2015 to September 2015. Ninety four patients undergoing vaginal delivery at term were randomized into two groups receiving either 10IU oxytocin or 100 μg carbetocin. Outcome measures such as primary PPH, massive blood loss, need for additional uterotonic drug, additional blood transfusion as well as adverse effects were documented. Results: In this study, massive blood loss did not occur none of patients in carbetocin group. But massive blood loss occured 6.4% women of oxytocin group. Further fundal massage , immediate blood transfusion and additional uterotonics didn’t need any patient in carbetocin group. In oxytocin group, fundal massage required in 8.5% of women, blood transfusion needed in 10.6% patients and additional uterotonics needed in 10.6% women. Average amount of blood loss was 88 ml less in carbetocin group and adverse effects of drugs were almost similar in both group. Primary PPH developed in oxytocin group 8.5% but none of patients had developed PPH in carbetocin group. Conclusion: Carbetocin is an effective new drug than oxytocin for prevention of postpartum hemorrhage in vaginal delivery. Bioresearch Commu. 7(1): 927-931, 2021 (January)
... 58-60 The evidence for their ee cacy is extremely wellestablished and, thus, additional elaboration will not be provided. 13,[61][62][63] In Singapore, there has been a reported increase in resistance rates of P. acnes from eight percent in 1999 to 14.9 percent in 2007. 4,39 Further, Tan et al 4 documented resistant P. acnes in school-attending adolescents who had not been previously treated for acne. ...
... Doxycycline and erythromycin are recommended rst-line oral antibiotics. 13,61,63 Doxycycline is contraindicated in children under eight years of age and in pregnant and lactating women. Erythromycin is as ee ective as tetracycline in the treatment of inn ammatory acne and is ee ective and safe for use in younger patients. ...
... Cotrimoxazole is recommended only as a third-line treatment when other options have failed. 61,69,70 It is ee ective, but has the potential for serious adverse events (e.g., Stevens-Johnson syndrome/ toxic epidermal necrolysis, bone marrow suppression). 61,70 It is also contraindicated among individuals who are G6PD-dee cient. ...
Due to the multiethnic patient population with varying skin types in Singapore, clinicians often find the management of acne in their patients to be challenging. The authors developed these guidelines to provide comprehensive advice on individualized acne treatment and to provide a reference guide for all doctors who treat patients of Asian descent. Unique features of acne in Singapore are highlighted. We address concerns such as diet, special population needs, and the benefits, side effects, risks, and cost-effectiveness of currently available acne treatments. These treatment guidelines outline recommendations for the diagnosis, grading, and treatment of children, adolescents, and adults with acne of varying severity, and include advice pertaining to the use of cosmeceuticals and management of scars.
... As a result of increase sebum production which is related to circulating androgen, a change in the skin natural flora will occur. Propionibacterium acnes, a normal component of the cutaneous flora, inhabits the pilosebaceous unit using lipid-rich sebum as a nutrient source .P acnes, therefore, flourishes in the presence of increased sebum production, leading to inflammation via complement activation and the release of metabolic byproducts, proteases, and neutrophil-attracting chemotactic factors (15,18) . When comedones are ruptured, the inflammatory acne vulgaris lesions such as papules, pustules, nodules or cyst will occur. ...
... This is mainly due to the lack of their full effects in the course of this disease, and the main agents that were included were Zinc, Vita-min A, Vitamin E, Selenium. However, a non-pharmacological option to help in the acne vulgaris approach is still a great way to provide the best possible health care to patients and that is one of the main reasons that this topic is being widely studied and on multiple dietary substances (17)(18)(19) . ...
... 1,4 Tetracycline, doxcycline, minocycline and erythromycin are the most widely used oral antibiotics worldwide. 1,[4][5][6] Adverse effects with oral anitibiotics are common, since they are taken for prolonged periods, and compliance is sometimes also a problem. 1 Recently, azithromycin has been used in acne patients. 1,4,5 It has a long tissue half -life and requires less frequent dosage, which is useful in increasing the compliance and tolerability of the patient. ...
... 1,5 A weekly pulse dose schedule of azithromycin has recently been introduced to treat acne for a period of 3 months and it significantly increase patients' compliance because of the reduced total number of administered drugs. 1,[5][6][7] Most of the patients in our study were in the 14-20 years age group, similar to the trend seen worldwide. 1,5 This is probably due to the fact that hormones at adolescence are at their peak in this age group. ...
Background: Acne is a very common skin disorder in our society. Azithromycin, an oral macrolide, has been found to be a new treatment for this disease. Objective: To assess the efficacy and safety of alternate day oral azithromycin 500 mg in the treatment of mild to moderate acne vulgaris.
... Vaginal candidiasis may occur in women and the influence when on the pill is not certain, giving recommendations to be extra cautious with contraceptives during therapy. [21,22] One particularly evident side effect in children is the potential yellowish discoloration and enamel hypoplasia of the developing teeth's. [21,23] Rare adverse effects are benign intracranial hypertension and photosensitivity. ...
... [21,22] One particularly evident side effect in children is the potential yellowish discoloration and enamel hypoplasia of the developing teeth's. [21,23] Rare adverse effects are benign intracranial hypertension and photosensitivity. [23] Regarding the inflammatory effect of LT-B4 in acne lesions and action mechanism of Montelukast, this study was performed to determine the efficacy of this drug in acne treatment and comparison with doxycycline as a pilot study. ...
Treatment of acne is an important issue for reducing the cosmetic and psychological burden of disease. Regarding the inflammatory effect of LT-B4 in acne lesions and action mechanism of Montelukast, this study was performed to determine the efficacy of Montelukastin acne treatment comparison with doxycycline.
In a randomized clinical trial that was performed in Dermatology Clinic in a Training Tertiary Health Care Center in Tehran, Iran since January 2012 to May 2014, 52 patients with moderate acne were evaluated. The included patients were randomly assigned to receive doxycycline 100 mg/day plus 1% Clindamycin solution (Group 1) or Montelukast 5 mg daily plus 1% clindamycin solution (Group 2). The acne severity index was measured and compared between two groups at baseline (on admission), 1-month and 3 months later. Independent-Sample-T, Chi-Square, and Repeated-Measure ANOVA tests were used and were considered statistically significant at P < 0.05.
The mean age was 26.8 ± 7.1 in Group 1 and25 ± 4.8 in Group 2 (P = 0.1). 73% women and 26.7% 4 men in Group 1 and 86.7% women, and 13.3% men in Group 2 (P = 0.01). The mean acne severity index at baseline was 18.2 ± 6.1 and 19 ± 4.2 in Montelukast and doxycycline group, respectively (P = 0.679). The mean acne severity index after 1-month was 10.5 ± 6.2 and 12.9 ± 3.3 in Montelukast and doxycycline group, respectively (P = 0). Finally, the mean acne severity index after 3 months follow-up was 8.6 ± 4.8 and 8.2 ± 1.2 in Montelukast and doxycycline group, respectively (P = 0.01). There was no significant difference between two groups regarding the amount of decrease in acne severity index across the study (P = 0.186). However, each groups showed a significant reduction in the acne severity index, separately (P = 0.001).
It may be concluded that Montelukast is an effective and safe medication for moderate-level acne treatment.
... Additionally, retinoids are associated with adverse drug reactions, such as skin dryness, erythema, and peeling caused by topical adapalene, as well as systemic side effects, including hepatotoxicity, elevated blood lipids, and teratogenicity from oral isotretinoin. These factors collectively increase the risk of treatment failure [5,6]. Hence, the quest for innovative pharmaceutical interventions is imperative in the realm of acne therapeutics. ...
Background
Acne vulgaris, a chronic inflammatory skin disorder, represents a pivotal research area in dermatology. Although fucoxanthin, a marine-derived carotenoid, displays potent anti-inflammatory activity, its therapeutic potential in acne pathogenesis remains underexplored.
Objective
This study investigates fucoxanthin’s effects on Propionibacterium acnes (P.acnes)-induced auricular inflammation in mice, focusing on its modulation of the IκBα/NF-κB signaling axis and inhibition of NF-κB nuclear translocation.
Methods
Inflammation in the ear of mice was induced using a P.acnes injection model. The anti-inflammatory effects of fucoxanthin were verified by evaluating the levels of erythema, pathological damage, and inflammatory factors in the mice ear. An in vitro model was constructed to explore the regulatory mechanism of IkappaBalpha (IκBα)/nuclear factor-kappaB (NF-κB) pathway by fucoxanthin.
Results
Fucoxanthin alleviated P. acnes-induced inflammatory pathology, reducing ear erythema. Mechanistically, it preserved IκBα stability, suppressed NF-κB nuclear translocation, and decreased proinflammatory cytokine production.
Conclusion
Fucoxanthin exerts anti-acne effects through coordinated inhibition of IκBα degradation and NF-κB nuclear translocation, establishing its potential as a targeted therapeutic agent for inflammatory acne.
... Commonly prescribed antibiotics are; azithromycin, doxycycline, ceftriaxone, cefixime, amoxicillin, cephradine, clindamycin, lidocaine, fusidic acid, metronidazole. The primary indication for oral antibiotic therapy in acne is moderate to severe inflammatory involvement on the face or trunk [65]. A serious problem with the extended use of oralantibiotic therapy is emergence of strains of bacteria that cause resistant to oral antibiotics e.g. ...
Background: Skin diseases are more common due to bacteria and fungi, mostly antibiotics, antifungal, NSAIDs, corticosteroids, antipsoriatics and antiacne agents are prescribed. 10% of hospital admissions are due to these ADRsthat include anaphylactic shock, hypersensitivity reactions. Monitoring of ADRs associated with the use of these drugs can be monitored by various ways including spontaneous reporting, yellow card scheme, direct patient reporting, and case control and cohort studies. Method: It is a retrospective study conducted by reviewing researcharticles and journals like Journal American Medical Association, JAMA, American Society of Health System Pharmacists, MedCare etc. relating to skin diseases and ADR monitoring relating to use of drugs for treatment from1969 to 2016. Conclusion: Most prevalent skin diseases are acne, microbial infections, psoriasis, hypersensitivityreactions, fungal infections and drug used for their treatment results in various adverse drug reactions which should be monitored during the therapy. These ADRs may be associated with minor to life threatening conditions.
... Antibiotics have played a significant role in the treatment of acne for many years. Antibiotic-resistant bacteria have unfortunately grown in number as a consequence of widespread usage of antibiotics (11). When it comes to prescribing antibiotics to patients, doctors have had to adapt to altering drug sensitivity patterns and the rise of more aggressive bacteria, like MRSA, that are more difficult to treat (12). ...
Acne is a skin disorder characterized by clogged hair follicles and chronic inflammation of the pilosebaceous follicles. A total of one hundred and five acne swabs were collected from patients with acne vulgaris infection at Baghdad's hospitals. For primary identification, 54 (45%) samples had a positive S. aureus culture on Mannitol salt agar (MSA) for 24 hours at 37°C. In addition, four pre-isolated also identified S. marcescens (pigment producers) which were identified by vitek-2 technique were taken for prodigiosin extraction, mineral salt broth with peptone (0.5 percent) was utilized, followed by pigment extraction, partial purification, also pigment measurement by spectrophotometer. Furthermore, using a microtiter plate assay, the bacterial ability to form biofilms was assessed for 20 S. aureus isolates (multidrug resistant isolates). The results revealed that only 8 strong isolates were biofilm producers, while 5 in addition 7 isolates were moderate also weak biofilm producers. The minimal inhibitory concentration of tetracycline also prodigiosin generated by isolated S. marcescens were determined using the broth microdilution technique for S. aureus isolates (S7 also S8). From overnight cultures of S. aureus (S7 also S8), DNA was effectively extracted.
... Antibiotics have played a significant role in the treatment of acne for many years. Antibiotic-resistant bacteria have unfortunately grown in number as a consequence of widespread usage of antibiotics (11). When it comes to prescribing antibiotics to patients, doctors have had to adapt to altering drug sensitivity patterns and the rise of more aggressive bacteria, like MRSA, that are more difficult to treat (12). ...
Acne is a skin disorder characterized by clogged hair follicles and chronic inflammation of the pilosebaceous follicles. A total of one hundred and five acne swabs were collected from patients with acne vulgaris infection at Baghdad's hospitals. For primary identification, 54 (45%) samples had a positive S. aureus culture on Mannitol salt agar (MSA) for 24 hours at 37°C. In addition, four pre-isolated also identified S. marcescens (pigment producers) which were identified by vitek-2 technique were taken for prodigiosin extraction, mineral salt broth with peptone (0.5 percent) was utilized, followed by pigment extraction, partial purification, also pigment measurement by spectrophotometer. Furthermore, using a microtiter plate assay, the bacterial ability to form biofilms was assessed for 20 S. aureus isolates (multidrug resistant isolates). The results revealed that only 8 strong isolates were biofilm producers, while 5 in addition 7 isolates were moderate also weak biofilm producers. The minimal inhibitory concentration of tetracycline also prodigiosin generated by isolated S. marcescens were determined using the broth microdilution technique for S. aureus isolates (S7 also S8). From overnight cultures of S. aureus (S7 also S8), DNA was effectively extracted.
... Treatment of acne involves a variety of topical and systemic medications such as antibiotics. However, many patients are contraindicated against or refractory to these medications [6]. Therefore, it is of interest to understand the molecular events underlying acne development and to search for novel Ivyspring International Publisher therapeutic strategies. ...
Acne vulgaris is a common skin disease, affecting over 80% of adolescents. Inflammation is known to play a central role in acne development. Here, we aimed to investigate the role of the central clock gene Bmal1 in acne-associated inflammation in mice. To this end, mice were injected intradermally with Propionibacterium acnes (P. acnes) to induce acne-associated skin inflammation. We found that Bmal1 and its target genes Rev-erbα, Dbp, Per1 and Cry2 were down-regulated in the skin of P. acnes-treated mice, suggesting a role of Bmal1 in the condition of acne. Supporting this, Bmal1-deleted or jet-lagged mice showed exacerbated P. acnes-induced inflammation in the skin. Regulation of P. acnes-induced inflammation by Bmal1 was further confirmed in RAW264.7 cells and primary mouse keratinocytes. Transcriptomic and protein expression analyses suggested that Bmal1 regulated P. acnes-induced inflammation via the NF-κB/NLRP3 axis, which is known to be repressed by REV-ERBα (a direct target of BMAL1). Moreover, loss of Rev-erbα in mice exacerbated P. acnes-induced inflammation. In addition, Rev-erbα silencing attenuated the inhibitory effects of Bmal1 on P. acnes-induced inflammation. Bmal1 knockdown failed to modulate P. acnes-induced inflammation in Rev-erbα-silenced cells. It was thus proposed that Bmal1 restrained P. acnes-induced skin inflammation via its target REV-ERBα, which acts on the NF-κB/NLRP3 axis to repress inflammation. In conclusion, Bmal1 disruption is identified as a potential pathological factor of acne-associated inflammation. The findings increase our understanding of the crosstalk between skin clock and acne and suggest targeting circadian rhythms as a promising approach for management of acne.
... Antibiotics are used in pathological situations, but they cause major dysbiosis with a relatively short time impact and rapidly promote resistance. 8 Alternative antimicrobial agents have been proposed, including antimicrobial peptides, but bacteria can develop resistance even against these natural substances. 9 Then, in many cases, and particularly for cosmetic products, the first target is to keep unchanged the skin microbial flora to prevent the vicious cycle responsible for inflammation and cutaneous discomfort. ...
With a view to reducing the impact of Cutibacterium acnes (C. acnes) on acne vulgaris, it now appears interesting to modify the balance between acneic and non‐acneic strains of C. acnes using moderate approach. In the present study, we identified that a G2 dendrigraft of lysine dendrimer (G2 dendrimer) was able to modify membrane fluidity and biofilm formation of a C. acnes acneic strain (RT5), whereas it appeared no or less active on a C. acnes non‐acneic strain (RT6). Moreover, skin ex vivo data indicated that the G2 is able to decrease inflammation (IL1α and TLR‐2) and improve skin desquamation after of C. acnes acneic strains colonization. Then, in vivo data confirmed, after C. acnes quantification by metagenomic analysis that the G2 cream after 28 days of treatment was able to increase the diversity of C. acnes strains versus placebo cream. The data also showed a modification of the balance expression between C. acnes phylotype IA1 and phylotype II abundances. Taken together, the results confirm the interest of using soft compounds in cosmetic product for modifying phylotype abundances and diversity of C. acnes strains could be a new strategy for prevent acne vulgaris outbreak.
... C. longa has an ability to scavenge the free radicles and thereby reducing the inflammation. Azimi et al. [18] in their study showed that turmeric and neem will not show any antibacterial effect, whereas it has well known antiinflammatory effect. A review article written by Sinha et al. [19] discussed the different plant species which offers great potential for screening acne. ...
Background
Acne is a chronic inflammatory disease of skin follicle on the face, which affects almost 85% youngsters and adolescents. The most common causative agent is Propionibacterium species. The evaluation of antimicrobial activity of turmeric and neem, two Indian herbs in facial cosmetics may provide a better treatment option for acne.
Objective
The review was to evaluate the microbiological characterization of Propionibacteria isolates from acne vulgaris cases and to identify the antimicrobial action against common antibiotics in use and different herbal extracts.
Method
A regimented search in the online databases such as PubMed, EMBASE, Google scholar, scopus and so on was done to identify relevant studies according to search strategies. Other search engines were also used, but could not extract relevant articles or studies form those electronic data bases. From the electronic search, 125 articles were identified, after title and abstract review, 96 articles were retained as eligible. A full-text evaluation resulted in 23 studies to be included for review.
Conclusion
The results suggests that Propionibacterium acnes is the main causative agent for pustular acne vulgaris and metronidazole was expectedly sensitive to P. acnes , whereas erythromycin and Clindamycin is emerging resistance.
... 10,11,12 As a first line systemic treatment in adolescence most authors recommend the use of systemic antibiotics, including tetracycline , doxycycline, minocycline and erythromycin. 13,14 Recently, azithromycin has been added to this list 814 Comparative clinical trials have shown that the tolerability profile of azithromycin is superior to that of erythromycin and doxycycline. 80Moreover tetracycline can cause both mucocutaneous and systemic adverse effects. ...
p> Introduction : Combination therapy is an effective approach to simultaneously target multiple pathogenic factor of acne. A unique combination of oral azithromycin pulse therapy and daily topical benzoyl peroxide has been developed for treatment of acne.
Material & Methods : It was an open, controlled, clinical trial, conducted on 37 out patients with acne vulgaris. Patients were clinically assessed at baseline &at week 0,4, 8 and 12. Evaluation included success rate (subjects clear or excellent improvement, good response), lesion count & percentage change in lesion count from baseline, cutaneous tolerability & adverse events.
Results : The combination of oral azithromycin pulse therapy & daily topical benzoyl peroxide was very safe & effective with significant differences in percentage of lesion count change observed as early as 1-4 weeks .Adverse events were more frequent with the combination therapy that occurred early in the study &were transient.
Conclusion : This study revealed that combination regimen of azithromycin &benzoyl peroxide (4%) is indeed very much efficacious & safe in the management of acne vulgaris.
J Bangladesh Coll Phys Surg 2018; 36(1): 11-15</p
... Evidence supporting staphylococcal involvement is still controversial, but topical and systemic antibiotics have been extensively prescribed to treat acne. Eventually, this led to the appearance of resistant and even life-threatening strains of bacteria -for example, methicillin-resistant S. aureus [14,15]. To use appropriate medications against staphylococci, its virulence factors should be adequately determined. ...
Background Staphylococcus aureus and Staphylococcus epidermidis have pathogenic role in the development of acne. Lipase enzyme is suggested to be involved in acne pathogenesis. However, the susceptibility of both bacteria to common antibiotics and whether lipase enzyme may affect such susceptibility is questioned. Objective To investigate antibiotic susceptibility of S. aureus and S. epidermidis isolated from acne lesions and explore the association between lipase enzyme and antibiotic resistance. Patients and methods Bacterial swabs from 102 patients with acne were sampled from acne lesions and microbial strains were isolated. S. aureus and S. epidermidis were analyzed for susceptibility to various antibiotics. Lipase enzyme was assessed in the isolated strains using Epsilometer test. Results Of the 102 isolates, S. aureus was detected in 18 (17.7%) specimens and S. epidermidis in nine (8.8%) specimens. Eleven (61.1%) specimens of the S. aureus isolates were sensitive to penicillin, whereas all S. aureus specimens (100%) were resistant to minocycline. S. epidermidis isolates showed the highest susceptibility to azithromycin and clarithromycin. Lipase enzyme was detected in 15 (83.3%) S. aureus-positive isolates and nine (100%) S. epidermidis-positive isolates. Neither the presence of lipase enzyme nor its activity was statistically related to the susceptibility of S. epidermidis and S. aureus to antibiotics. Conclusion Although, Staphylococci spp. isolated from acne lesions showed lipase activity and high prevalent rates of antimicrobial resistance, the association between lipase enzyme and antibiotic susceptibility was statistically insignificant.
... Antibiotic therapy has been integral part to the treatment of acne for many years. The widespread and long-term use of antibiotics has unfortunately led to the emergence of resistant bacteria (Tan and Tan, 2005). ...
In this study, twenty five samples were collected from acne, ranging from 20 to 25 years old patients. The specimens were cultured on trypticase soy agar (TSA) plate. 25 suspected single colonies were isolated using mannitol salt agar. Isolates were identified by short biochemical tests such as catalase, coagulase, oxidase and Gram staining test. Five Staphylococcus aureus and eleven Staphylococcus epidermidis strains were identified. Antibiotic sensitivity of all strains was tested according to the Kirby-Bauer method using commercially available gentamicin, erythromycin, azithromycin, oxacillin, clindamycin and rifampicin discs. 100% of the isolates were sensitive to gentamicin and rifampicin. On the other hand, 93.75% isolates were sensitive to oxacillin, erythromycin and azithromycin and 81.25% isolates were sensitive to clindamicin. Minimum inhibitory concentration (MIC) of rifampicin and gentamicin was determined by test tube serial dilution method and it was found to be 4 μg/ml for both. Our results showed that both rifampicin and gentamicin are effective antibacterial agents for acne.Bangladesh Pharmaceutical Journal 18(2): 121-125, 2015
... In cases of poor clinical response despite adequate compliance, oral antibiotic is substituted to a second line agent. 16,17 The majority of our patients (98.2%) were concomitantly treated with topical agents. Oral antibiotic therapy is best used in combination with a topical regimen that includes benzoyl peroxide and retinoid. ...
Antibiotic resistant P. acnes have influenced acne therapy worldwide resulting in increased use of topical and systemic retinoids. Judicious use of oral antibiotic is important for effective therapeutic outcome.
To determine the response and side effects of oral antibiotic treatment in acne vulgaris. To determine the type of antibiotic used, therapy duration and the types of concomitant topical therapy.
Retrospective analysis of the therapeutic response to oral antibiotics therapy in acne vulgaris in the Dermatology Department, Hospital Kuala Lumpur. New cases of acne vulgaris from 2005 to 2009 were randomly selected. The clinical notes of 250 patients treated with oral antibiotics were reviewed.
About 60% of patients achieved good to excellent response to therapy while satisfactory response was seen in 26%. Only 8% patients experienced minor side effects. Doxycycline was the most frequently prescribed antibiotic, followed by tetracycline and erythromycin ethylsuccinate. The prescribing pattern was consistent over the years. The mean duration of treatment is four to five months. Oral antibiotic was augmented with topical therapy in 98.8% of patients.
Good to excellent therapeutic response was achieved in the majority of patients and results observed have remained stable over the last five years.
... Propionibacterium acnes a normal component of the cutaneous flora, invade the pilosebaceous unit using lipid rich sebum as a nutrient source and grow in the presence of increased sebum production leading to inflammation via complement activation and the release of metabolic byproducts, proteases and neutrophil-attracting chemotactic factors [41,44]. When comedones ruptures, the contents of the pilosebaceous unit spread into the adjacent dermis and it leads to development of inflammatory acne vulgaris lesions such as; cysts, nodules, papules and pustules [41,45]. ...
Acne vulgaris is one of the most common dermatological disorders that afflict people in
their adolescence. Acne vulgaris or simply known as acne is a human skin disease
characterized by skin with scaly red skin (seborrhea), blackheads and whiteheads
(comedones), pinheads (papules), large papules (nodules), pimples and scarring. Acne
vulgaris is a disease of pilosebaceous unit characterized by the formation of open and
closed comedones, papules, pustules, nodules and cysts. Acne affects skin having dense
sebaceous follicles in areas including face, chest and back. Acne is not life threatening
but severe acne can affect psychological status and social activities. The present review
focuses on an epidemiology, etiology, pathogenesis, diagnosis, differential diagnosis and
management of acne with the pharmaceutical dosage forms of oral and topical
administrations. Various medicines for acne treatment includes benzoyl peroxide,
antibiotics, antiseborrheic medications, sulfur and sodium Sulphacetamide, antiandrogen
medications, salicylic acid, hormonal treatments, alpha hydroxy acid, retinoids,
azelaic acid, keratolytic soaps and nicotinamide. Currently laser and light devices and
minor subcision surgery have been also performed for acne treatment.
... Antibiotic therapy has been integral to the treatment of acne for many years. The widespread and long-term use of antibiotics has unfortunately led to the emergence of resistant bacteria (5). Combination therapy with a topical retinoid and an antibiotic is recognized as an effective method for the management of acne vulgaris. ...
The multiple etiologic factors involved in acne make the use of various medications necessary to treat the condition. This study aimed to determine the efficacy of mupirocin and rifampin used with standard treatment in the management of acne vulgaris. In a multicentre, randomized controlled, triple-blinded study, a total of 105 acne patients, with a clinical diagnosis of moderate to severe acne,were randomizedly divided into three groups (35 per group), for treatment of acne. The first group was treated with standard treatment alone, the second group received mupirocin plus standard treatment and the third group received rifampin plus standard treatment.There were three study visits according to Global Acne Grading System (GAGS): at baseline and weeks 6 and 12. The absolute changes of GAGS score from baseline to week 6 and 12 demonstrated a reduction in the mean score of GAGS in the three treatment groups (p < 0.001). Due to the difference between GAGS score at the baseline of study, the data were adjusted using the general linear model. The findings showed that all of the treatments significantly improved acne lesions. Nevertheless, none of the treatments was shown to be more effective than the others (p = 0.9). The three treatments were well tolerated, and no serious adverse events were reported. These findings provide evidence on the efficacy of combining mupirocin and rifampin with standard treatment in the management of acne vulgaris, although none of the treatments had superior efficacy compared with the others.
... Results and discussion P. acnes, an anaerobic pathogenic inhabitant of human skin, plays an important role in pathogenesis of acne. For many years antibiotics and hormones were usually applied to treat acne [23,24]. However, these agents are often accompanied by severe side effects and drug resistance [25,26]. ...
In our investigation to find out new anti-acne agent, we focused on Terminalia laxiflora Engl & Diels (Combretaceae) methanolic wood extract, which has been selected during previous screening experiments for anti-acne agents, which included 29 species of Sudanese medicinal plants. Based on the biologically guided fractionation using an antibacterial assay against Propionibacterium acnes, a lipase inhibitory assay and 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity assay; five tannin-related compounds were isolated, such as ellagic acid, flavogallonic acid dilactone, terchebulin and gallic acid. Terchebulin showed good antibacterial activity; minimum inhibitory concentration (MIC) = 125 μg/ml and minimum bactericidal concentration (MBC) = 250 μg/ml. Gallic acid exhibited lipase inhibitory activity with IC50 value of 149.3 μM, which showed strong inhibition compared with terchebulin, IC50 260.7 μM. However, all compounds exhibited better or equal DPPH radical scavenging activity to (+)-catechin as positive control. Ellagic acid and terchebulin showed the best DPPH radical scavenging activities, IC50 4.86 and 4.90 μM, respectively. This study demonstrated that terchebulin has potentiality as an anti-acne agent.
... The practical implication of this feature of CTnDOT-type elements is that one human practice, the dermatological use of tetracycline, might have contributed to the increased spread of tetQ over the 3-decade period covered in our survey. People with skin conditions, such as acne and rosacea, routinely receive oral tetracycline for periods that can range from months to years (46,47). ...
Although bacteria can become resistant to antibiotics by mutation, a far quicker and easier way for them to achieve the same goal is to acquire pre-formed resistance genes from other bacteria. It is well established that such transfers across species and genus lines occur under laboratory conditions, but the important practical question is whether such transfers actually occur in situ and, if so, whether they occur rarely or frequently. Part II of this article summarizes the evidence that antibiotic resistance genes are, in fact, being transferred among bacteria in the colon and then goes on to explore how and why investigators are trying to determine what conjugative elements mediate this transfer.
... The widespread use of antibiotics has unfortunately led to the emergence of resistant bacteria. [6] In addition, changing patterns of antibiotic sensitivity and the emergence of more virulent pathogens, such as community‑acquired methicillin‑resistant Staphylococcus aureus (MRSA), have led to marked changes in how clinicians use antibiotics in clinical practice. [7] There is significant in vitro evidence suggesting a possible pathogenetic role for S. aureus in acne vulgaris. ...
There is considerable evidence which suggests a possible pathogenetic role for Staphylococcus aureus (S. aureus) in acne vulgaris.
The study was to determine S. aureus colonization and antibiotic susceptibility patterns in patients with acne and of healthy people.
In the case-control study, a total of 324 people were screened for nasal carriage of S. aureus: 166 acne patients and 158 healthy persons. One control subject was individually matched to one case. Nasal swabs from anterior nares of individuals were cultured and identified as S. aureus. Antibiotic sensitivity was performed with recognized laboratory techniques.
S. aureus was detected in 21.7% of the subjects in acne, and in 26.6% of control groups. There was no statistical difference in colonization rates between two groups (P=0.3). In patient group, most of S. aureus isolates were resistant to doxicycline and tetracycline (P=0.001), and were more sensitive to rifampicin compared to other drugs. In control samples, the isolated demonstrated higher resistance to cotrimoxazole compared to patient samples (P=0.0001). There was no difference between groups regarding resistance to rifampicin, vancomycin, methicillin, and oxacillin.
It is still unclear whether S. aureus is actually a causal agent in the pathogenesis of acne. Based on microbiological data of both healthy and acne-affected persons, we propose that contribution of S. aureus in acne pathogenesis is controversial.
El acné vulgar (AV) es una condición inflamatoria común que afecta a muchos, especialmente a jóvenes, y es provocada por la sobreproducción de sebo y la proliferación de C. acnes. Aunque los antibióticos son efectivos en su tratamiento, su uso prolongado ha generado preocupación por la resistencia bacteriana, lo que ha llevado a combinación con otros tratamientos. El objetivo principal es actualizar conocimientos sobre el manejo de la hipertensión gestacional. En octubre del 2024, se realizó un artículo de revisión acerca del acné vulgar y su tratamiento, este está basado en estudios de los últimos 5 años encontrados en base de datos como PubMed, MEDLINE, EMBASE y Google Académico. Se identificaron 20 estudios que cumplen con los criterios de inclusión e incluyen definición, fisiopatología, clasificación, manejo antibiótico tópico, sistémico y otras alternativas de tratamiento del tema descrito. El manejo del acné vulgar debe ser multidimensional, combinando tratamientos y limitando el uso de antibióticos para reducir el riesgo de resistencia bacteriana. La investigación continua es esencial para desarrollar estrategias más efectivas y seguras en su tratamiento.
Introduction:
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit that affects approximately 9.4% of the global population. Current treatment strategies aim to target as many pathogenic factors involved in the appearance of acne lesions and are centered on a systematic treatment escalation based on disease severity, extension, and treatment response, starting with topical treatments for mild cases and progressing over to systemic therapies in more severe cases. A literature search, which included clinical guidelines, clinical studies, and review articles on acne treatment and maintenance, was conducted to review the pharmacological approaches currently available to treat this disease.
Areas covered:
Topical therapies such as topical retinoids, benzoyl peroxide, azelaic acid, salicylic acid, topical antibiotics, and clascoterone, as well as systemic treatments such as oral antibiotics and isotretinoin are discussed in detail. Combined oral contraceptives and spironolactone will not be discussed in this article.
Expert opinion:
There is a need for a blockbuster acne drug that simultaneously targets the four main pathogenic factors involved in the appearance of acne lesions while presenting with minimal side effects. Until such a drug exists, combination therapy will remain the standard of treatment for most acne patients.
Acne is a common skin condition that can have profound physical and psychological impacts. This article outlines its clinical presentation and recommended management in primary care and discusses when referral to secondary care is necessary.
Introduction:
Many international guidelines and expert consensuses are available to help the clinician diagnose and treat acne vulgaris; however, a simplified practical guidance that integrates current existing published recommendations is still lacking. This article aims to give practical and simplified insight into the treatment of acne.
Areas covered:
Herein, the author discusses the treatment of comedonal, papulopustular and nodular/cystic/conglobate acne. The author also proposes a simplified treatment escalation strategy that is based on disease severity and extension, starting with topical treatments for mild cases and progressing over to systemic therapies in more severe cases.
Expert opinion:
The ideal acne treatment would simultaneously and safely target all the pathogenic factors implicated in the appearance of acne lesions with minimal side effects. Since no such treatment currently exists, combination therapies are usually recommended for most types of acne. A major limitation in choosing an appropriate treatment plan is the discrepant use of classification systems across the published literature making it difficult to draw clear and succinct conclusions about the recommendations given. Acne is not a traditional infectious disease and so while antibiotics may improve symptoms, they do not reliably resolve the condition. Thus, there is currently a tendency to opt for antibiotic-sparing treatment strategies whenever possible.
Antibiotic resistance is a growing health concern that has attracted increasing attention from clinicians and scientists in recent years. While resistance is an inevitable consequence of bacterial evolution and natural selection, misuse and overuse of antibiotics plays a significant role in its acceleration. Antibiotics are the mainstay of therapy for common dermatoses, including acne and rosacea, as well as skin and soft tissue infections. Therefore, it is critical for dermatologists and physicians across all disciplines to identify, appropriately manage, and prevent cases of antibiotic resistance. This review explores dermatologic conditions in which development of antibiotic resistance is a risk and discusses mechanisms underlying the development of resistance. We discuss disease-specific strategies for overcoming resistant strains and improving antimicrobial stewardship along with recent advances in the development of novel approaches to counter antibiotic resistance.
Skin is the largest organ of the body and the biggest barrier against pathogens. Skin diseases have become one of the most challenging medical problems in clinical practices, and a tremendous burden to the healthcare system in terms of cost and consumption of institutional resources. The emergence of drug resistance is a threat and concern in various clinical implications of skin diseases, particularly those that have secondary intervention such as chemotherapy, as the main treatment option. Multidrug-resistant organisms include bacteria and other microorganisms that have grown resistance to antimicrobial drugs. Resistance to antimicrobial drugs reduces the effectiveness of treatment and increases the severity of dermatologic diseases. Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-Resistant Enterococci (VRE), and multidrug-resistant gram-negative rods (MDR GNR) bacteria are the common multidrug-resistant organisms (MDROs). Skin cancers have poor prognosis and treatment options, due to resistance to conventional chemotherapies. The exact mechanisms of resistance in skin cancers are not known, however most tumors likely resist through reduced apoptosis. Many molecular pathways, enzymes and genes are implicated in the process of reduced “apoptosis induction”. Similarly, acyclovir (ACV) and related analogues are successful drugs against HSV infections, however the emergence of drug resistance to ACV has become an obstacle in the treatment of HSV infections, especially in patients with low immunity. In this chapter, we have attempted to discuss major skin diseases and relevant factors that contribute to drug resistance in many dermatologic conditions.
Acne Vulgaris is one of the most common dermatologic disorders affects people of all races and ethnicities and has many adverse effects on the quality of life. The increased bacterial resistance to antibiotics has reduced the effectiveness of treatment with these agents. There is an increasing focus on the involvement of oxidative stress in the pathophysiology of acne. This study investigates the effect of N‐acetylcysteine as an antioxidant in the treatment of acne vulgaris. This systematic review was conducted through a search in databases such as Science Direct, PubMed, Scielo and Medline using keywords including acne vulgaris, anti and N‐acetylcysteine, and all the keywords associated with each of the subtitles.
The factors affecting the occurrence and expansion of acne include increased sebum synthesis, hyperkeratinization of pilosebaceous units, colonization with Propionibacterium acnes, and increased release of inflammatory mediators and ROS. Studies have shown that glutathione stimulation following the administration of NAC increases glutathione levels for the detoxification of oxygen free radicals. Moreover, NAC prevents the synthesis and release of inflammatory cytokines such as TNF‐α, IL‐8, IL‐6, MP9, and IL‐1β and has shown antibacterial activities against important bacteria including E.coli, S. epidermidis, Pseudomonas and Klebsiella. This medication has anti‐proliferative effects and is also used for excoriation and PCOD.
The results of the present study showed the beneficial effects of using N‐acetylcysteine in patients with acne vulgaris in terms of the disease complications and comorbidities. Given its diverse functional mechanisms, this medication can be used to treat acne and its consequences.
This article is protected by copyright. All rights reserved.
Systemic antibiotics play a vital role in dermatology, with oral antibiotics representing approximately 20% of all outpatient prescription written by dermatologists annually. Thus, a thorough understanding of these agents is imperative for the practicing dermatologist. This chapter reviews the major classes of antibiotics frequently used in dermatology. For each antibiotic class, we will review the mechanism of action, antimicrobial activity, pharmacokinetics, major dermatologic indications, and important adverse effects, including cross-reactions and drug interactions. In addition, mechanisms of resistance are highlighted throughout the text. Finally, two special topics—treatment of methicillin-resistant Staphylococcus aureus and Clostridium difficile–associated disease—are explored.
Oral antibiotics are integral for treating inflammatory acne based on what is understood about the pathogenesis as well as the role of Cutibacterium acnes. However, rising concerns of antibiotic resistance and the perception of "antibiotic phobia" create potential limitations on their integration in an acne treatment regimen. When prescribing oral antibiotics, dermatologists need to consider dosage, duration, and frequency, and to avoid their use as monotherapy. These considerations are important, along with the use of newer strategies and compounds, to reduce adverse-event profiles, antibiotic resistance, and to optimize outcomes. Aside from concomitant medications, allergies, and disease severity, costs and patient demographics can influence variability in prescribing plans. There are multiple published guidelines and consensus statements for the USA and Europe to promote safe antibiotic use by dermatologists. However, there is a lack of head-to-head studies and evidence for comparative superiority of any individual antibiotic, as well as any evidence to support the use of agents other than tetracyclines. Although oral antibiotics are one of the main options for moderate to severe acne, non-antibiotic therapy such as isotretinoin and hormonal therapies should be considered. As newer therapies and more outcomes data emerge, so will improved management of antibiotic therapy to foster patient safety.
Introduction: Acne vulgaris is the most common skin disease worldwide, yet current treatment options, although effective, are associated with unwanted side effects, chronicity, relapses and recurrences. The adequate control of the four pathogenic mechanisms involved in the appearance of acne lesions is key to treatment success. This paper aims to discuss the novel treatment modalities that have surfaced in consequence of new knowledge obtained in acne pathogenesis.
Areas covered: Pathogenic pathways are evaluated and discussed throughout the paper in relation to the mechanisms of action of novel molecules being investigated for the treatment of acne vulgaris. A comprehensive search was made in PubMed and Clinicaltrial.gov using a different combination of keywords, which included acne vulgaris, treatment, therapy, and therapeutic.
Expert opinion: In the near future, more effective treatments with less side effects are expected. The use of topical anti-androgens, coenzyme-A carboxylase inhibitors, and insulin growth factor-1inhibitors to control sebum production seem promising. Selective RAR-agonists have the potential of becoming an alternative to the currently available retinoid therapy in the management of infundibular dyskeratosis with a better safety profile. Antibiotic use will probably decline as more effective options for controlling Cutinebacterium acnes colonization and the inflammation cascade emerge.
Excessive or uncritical worldwide use of antibiotics in medicine has accelerated the selection and spread of resistant bacteria. In some areas many antibiotics have become ineffective for infections which had previously been well susceptible to antibacterial agents. Dermato-venereologists have used oral and topical antibiotics routinely to treat acne vulgaris, although acne is neither an infectious disease nor triggered exclusively by Propionibacterium. It is rather a complex chronic inflammatory skin disorder based on multiple pathogenic factors including follicular hyperkeratinization, increased sebum production, bacterial proliferation and inflammation. Consequently, effective treatment should target multiple pathogenic factors instead of primarily Propionibacterium acnes. Therefore, topical retinoids and benzoyl peroxide have been defined as the standard first-line drugs. Monotherapy with local antibiotics should be avoided altogether. Systemic antibiotics of the tetracycline group still have their indication in certain stages of acne, but their efficacy may be based rather on anti-inflammatory than antibiotic actions. Health authorities are urging all healthcare providers to limit antibiotic use. The risk-benefit ratio must be carefully observed between the need for antibiotic treatment in the individual patient and the public interest in preserving the effectiveness of antibiotics. Here we summarize the current concept of acne vulgaris and its consequences for the use of antibiotics.
Zusammenfassung
Der übermäßige oder unkritische weltweite Einsatz von Antibiotika in der Medizin hat die Ausbreitung von Antibiotikaresistenzen beschleunigt. In einigen Bereichen sind viele Antibiotika bei bakteriellen Infektionen, die zuvor noch gut auf antibakterielle Wirkstoffe reagierten, mittlerweile wirkungslos geworden. Dermatologen/Venerologen setzten orale und topische Antibiotika bei der Behandlung von Acne vulgaris routinemäßig ein, obwohl Akne weder eine infektiöse Erkrankung ist noch alleine durch das Propionibacterium getriggert wird. Vielmehr ist sie eine komplexe, chronische entzündliche Hauterkrankung, die durch verschiedene pathogenetische Faktoren wie follikuläre Hyperkeratose, erhöhter Sebumproduktion, bakterielle Proliferation und Entzündung zustande kommt. Folglich sollte eine erfolgreiche Therapie auf die Bekämpfung verschiedener pathogenetischer Faktoren und nicht nur auf die von Propionibacterium acnes abzielen. Daher wurden topische Retinoide und Benzoylperoxid als Mittel der ersten Wahl definiert. Monotherapien mit lokalen Antibiotika sollten insgesamt vermieden werden. Systemische Antibiotika der Tetrazyklin‐Gruppe haben bei bestimmen Krankheitsstadien ihren Sinn, ihre Wirkung könnte aber eher auf der antientzündlichen als auf der antibiotischen Reaktion beruhen. Gesundheitsbehörden ermahnen alle Gesundheitsdienstleister, den Einsatz von Antibiotika einzuschränken. Das Nutzen‐Risiko‐Verhältnis muss bei der Entscheidung für oder gegen eine antibiotische Therapie bei einem einzelnen Patienten immer auch in Bezug auf das öffentliche Interesse am Erhalt der Wirksamkeit von Antibiotika abgewogen werden. Im Folgenden werden das aktuelle Krankheitskonzept zu Acne vulgaris und die sich daraus ableitenden Konsequenzen für den Einsatz von Antibiotika vorgestellt.
In this issue of Experimental Dermatology, dr. Melnik presents the hypothesis that acne is caused by inappropriate survival of cells in the sebaceous duct and gland. He proposes in particular that TRAIL mediated apoptosis is inhibited by ductal hypoxia. If it works out, this intriguing idea would suggest interesting new therapies. In my comment, I offer a critical appraisal - the TRAIL to acne pathogenesis might be rather different from what dr. Melnik would have us believe. This article is protected by copyright. All rights reserved.
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the efficacy and safety of topical antibiotics for the treatment of acne vulgaris.
Salicylzuur heeft geen plaats in de behandeling van acne.
Orale anticonceptiva met cyproteronacetaat worden niet langer aanbevolen.
Doxycycline is het eerste keus oraal antibioticum in plaats van tetracycline.
Topical antimicrobial treatment is indicated for mild to moderate acne vulgaris. Our literature review includes searches of Ovid, MEDLINE, EMBASE, and the databases of the Cochrane Library. A detailed search strategy is included. All searches were limited to controlled trials and systematic reviews. No year limits were applied to the searches, but we focused on trials, guidelines, and reviews published since 2004, the year that the last review of topical antimicrobials was published in this journal. Several controlled trials demonstrate that benzoyl peroxide, topical antibiotics, and topical retinoids used in combination provide the greatest efficacy and safety profile for the treatment of mild to moderate acne, but there are few trials directly comparing different combinations of these topical therapies with one another. Additionally, robust studies comparing cost and efficacy of generic combinations of the above agents with proprietary fixed-dose combination therapies that may increase compliance are also lacking. Although they have not been extensively studied, alternative agents including dapsone, salicylic acid, azelaic acid, and zinc are safe and efficacious when combined with traditional therapies.
Many known or suspected health hazards awaken uneasiness as soon as they are mentioned, before any quantitative risk analysis is offered. Chemicals that might cause cancer or birth defects, hidden contaminants spreading in food or water or air, and invisible but possibly deadly radiation are among the hazards that directly engage our emotions. They may stir revulsion, outrage, and an impetus toward action, even if the sizes of the health risks that they create are unknown. Public concern about such threats can be amplified by news stories that present vivid anecdotes and plausible-sounding (even if unproved) conjectures about cause and effect, as well as by deliberate political, scientific, or corporate fear-mongering designed to galvanize particular actions or further particular agendas (Gardner 2009). Quantitative risk analysis (QRA) of the frequencies and severities of adverse effects caused by these hazards may have relatively little influence on the outcomes of such emotionally charged proceedings. And yet, QRA information is essential for deciding how to allocate limited social attention and resources most effectively to obtain substantial reductions in harm to human health.
The movement of antibiotic resistance genes, as opposed to the movement of resistant bacterial strains, has become an issue of interest in connection with clinical and agricultural antibiotic use patterns. Evidence to date suggests that extensive DNA transfer is occurring in natural settings, such as the human intestine. This transfer activity, especially transfers that cross genus lines, is probably being mediated mainly by conjugative transfer of plasmids and conjugative transposons. Natural transformation and phage transduction probably contribute mainly to transfers within species or groups of closely related species, but the extent of this contribution is not clear. A considerable amount of information is available about the mechanisms of resistance gene transfer. The goal of future work on resistance ecology will focus on new approaches to detecting gene transfer events in nature and incorporating this information into a framework that explains and predicts the effects of human antibiotic use patterns on resistance development.
Oral antibiotics have been used for the treatment of acne vulgaris for six decades. Among dermatologists, tetracyclines represent at least three-fourths of the oral antibiotics prescribed in clinical practice. Unlike other specialties, antibiotic use in dermatology is predominantly for the treatment of noninfectious disorders, such as acne vulgaris and rosacea, which usually involves prolonged therapy over several weeks to months as compared to short courses used to treat cutaneous infections. At the present time, doxycycline and minocycline are the most commonly prescribed tetracyclines in dermatology, used primarily for treatment of acne vulgaris with a long overall favorable track record of effectiveness and safety. Although both are commonly used, doxycycline may be chosen by clinicians more readily as there is a lower risk of rare yet potentially serious adverse reactions, although doxycycline does warrant preventative measures to reduce the risks of esophagitis and phototoxicity reactions. This article reviews data with a new double-scored small 150mg tablet of doxycycline hyclate that has proven functional scoring, exhibits bioavailability similar to enteric-coated doxycycline, and has been shown to be associated with a low potential for gastrointestinal adverse reactions very comparable to what is achieved with enteric-coated tablets.
Acne is a common skin condition in adolescents. It is not uncommon in childhood and it persists into adulthood. A broad range of acne treatments are available and have been shown to be safe and effective in adolescents and adults. However, there is limited literature regarding acne treatment in childhood and its available therapeutic options. It seems reasonable to extrapolate findings of the various studies reported on treatment of acne in the adolescent and adult age group, with the exclusion of the use of tetracycline derivatives. As clinicians, we must be more familiar with the clinical presentation of acne and available treatment options in our younger patients. Early recognition of acne with prompt and appropriate initiation of therapy in childhood will help prevent severe scarring in children.
Acne vulgaris is a common inflammatory skin condition affecting most individuals at some point during their lives. Although acne is more commonly seen in adolescents, it can be seen in younger patients as well. It can be useful to classify pediatric acne based on the age of presentation as infantile, mid-childhood, or preadolescent. We describe a practical approach to the evaluation and treatment of acne in each of these age groups.
ABSRACT
Purpose: In the present study an attempt was made to evaluate the
chemical composition of essential oils of rhizomes of Zingiber
capitatum Methods: Chemical composition of Zingiber capitatum
essential oil was evaluated by GC-MS analysis along with its
biological screening for antimicrobial and antioxidant properties.
Results: GC-MS analysis showed that presence of 7 compounds in the
essential oil 1, 8-cineole (36.23%), Linalool (30.9%), Tricyclene
(17.80%) β-Pinene (7.29%), 3-cyclohexane-1 methanol, alpha, alpha-
4-trimethyl (3.31%), methyl-3-benzoate (2.25%) and α-terpineol
(2.22%). In vitro antimicrobial activity of the essential oil showed
moderate antimicrobial activity against the test pathogens. The
antioxidant properties of the essential oil evaluated by DPPH (α,α-
Diphenyl-β-Picryl-hydrazyl) scavenging assay, H2O2 scavenging assay, total antioxidant
capacity, total phenol content, β carotene and Lycopene content showed strong results.
Conclusion: The present study revealed that the essential oil is rich in bioactive compounds
like 1, 8-cineole, Linalool, β-pinene, and terpineol with strong antimicrobial and antioxidant
properties.
Die Entwicklung einer Vernarbung durch mittelschwere und schwere entzündliche Formen der Acne vulgaris kann für den Betroffenen lebenslange psychosoziale Konsequenzen haben. Der frühzeitige Einsatz systemischer Aknetherapeutika kann diese Verläufe verhindern. Antiinflammatorisch wirksame Antibiotika wie Tetracycline sind bei papulopustulösen Akneformen indiziert und sollten über einen Zeitraum von 3 Monaten verabreicht werden. Die Kombination mit topischen Retinoiden führt zu einer schnelleren und effektiveren Reduktion der Akneeffloreszenzen, während Benzoylperoxid die Entwicklung bakterieller Resistenzen verhindert. Orales Isotretinoin ist indiziert bei schweren Akneformen ohne ausreichendes Ansprechen auf konventionelle Behandlung. Bei Frauen stellt eine antiandrogene Hormontherapie eine wirkungsvolle Therapiealternative dar, die obligat beim Vorliegen einer Acne tarda und klinischen Androgenisierungszeichen zum Einsatz kommt.
Monocycline is the most widely prescribed systemic antibiotic for acne largely because it needs to be given only once or twice a day and seems not to induce resistance. Up to April 1994 11 cases of minocycline induced systemic lupus erythematosus and 16 cases of hepatitis had been reported to the Committee on Safety of Medicines. An analysis of these cases together with seven other cases shows the severity of some of these reactions. Two patients died while taking the drug for acne and a further patient needed a liver transplant. Acne itself can induce arthritis and is often seen in association with autoimmine liver disease, but the clinical and biochemical resolution seen after withdrawal of the drug, despite deterioration of the acne, suggests a drug reaction. In five cases re-exposure led to recurrence. Because reactions may be severe early recognition is important to aid recovery and also to avoid invasive investigations and treatments such as corticosteroids and immunosuppresants. Safer alternatives should be considered for treating acne.
Background:
Oral isotretinoin (Roaccutane) revolutionized the treatment of acne when it was introduced in 1982.
Methods:
Twelve dermatologists from several countries with a special interest in acne treatment met to formally review the survey of their last 100 acne patients treated with oral isotretinoin. The primary purpose of the survey was to identify the types of acne patients who were prescribed oral isotretinoin and how the patients were managed.
Results:
Of the 1,000 patients reviewed, 55% of those who received oral isotretinoin had those indications treated historically, i.e. severe nodular cystic acne or severe inflammatory acne, not responding to conventional treatment. Forty-five percent of patients who were prescribed oral isotretinoin however had either moderate or mild acne. Most patients in this group had moderate acne (85%). However, 7.3% had mild acne on physical examination. The criteria for prescribing oral isotretinoin in this less severe group of patients included acne that improves < 50% after 6 months of conventional oral antibiotic and topical combination therapy, acne that scars, acne that induces psychological distress and acne that significantly relapses during or quickly after conventional therapy. Treatment is usually initiated at daily doses of 0.5 mg/kg (but may be higher) and is increased to 1.0 mg/kg. Most of the physicians aimed to achieve a cumulative dose of > 100-120 mg/kg. Mucocutaneous side-effects occur frequently but are manageable while severe systemic side-effects are rarely problematic (2%). The teratogenicity of oral isotretinoin demands responsible consideration by both female patients and their physicians. Significant cost savings when treating acne patients with oral isotretinoin as compared to other treatment modalities were further proven in this study.
Conclusions:
Our recommendation is that oral isotretinoin should be prescribed not only to patients with severe disease but also to patients with less severe acne, especially if there is scarring and significant psychological stress associated with their disease. Acne patients should, where appropriate, be prescribed isotretinoin sooner rather than later.
A multicentre, randomised, double-blind and double-dummy study was conducted to compare the efficacy and safety of lymecycline (n = 71) with that of minocycline (n = 73) in 144 patients with moderately severe acne vulgaris. Patients with an acne score of 1-5 on the Leeds scale received oral lymecycline, 300 mg/day for 2 weeks, then 150 mg/day for 10 weeks or oral minocycline, 100 mg/day for 2 weeks then 100 mg every other day for 10 weeks. Inflammatory, non-inflammatory and total lesion counts were determined at baseline (week 0) and after 4, 8 and 12 weeks' treatment, and global efficacy and safety assessments were made by the patient and investigator at the end of the study. Both treatments were equally effective at reducing differential lesion counts and improving acne condition and severity, with no significant differences between treatments. Inflammatory lesions were reduced by 50.6% and 52.2% with lymecycline and minocycline, respectively, and non-inflammatory lesions by 40.6% and 32.2%. Acne severity was reduced by 42.4% with lymecycline and by 47.9% with minocycline. A total of 4.3% of lymecycline recipients and 4.1% of minocycline recipients experienced treatment-related adverse events, the majority of which were mild in nature. Lymecycline was as effective as minocycline for the treatment of moderately severe acne vulgaris. Both treatments were well tolerated, although there were slightly fewer adverse gastrointestinal and dermatological effects with lymecycline.
• Pseudomembranous colitis was observed on two occasions in the same patient and was associated with the topical administration of clindamycin phosphate. Assay for Clostridium difficile toxin was positive, and the patient was ultimately cured by oral vancomycin hydrochloride and the withdrawal of clindamycin therapy.(Arch Dermatol 1986;122:583-584)
Topical antibacterial agents are an essential part of the armamentarium for treating acne vulgaris. They are indicated for mild-to-moderate acne, and are a useful alternative for patients who cannot take systemic antibacterials. Topical antibacterials such as clindamycin, erythromycin, and tetracycline are bacteriostatic for Propionibacterium acnes, and have also been demonstrated to have anti-inflammatory activities through inhibition of lipase production by P. acnes, as well as inhibition of leukocyte chemotaxis. Benzoyl peroxide is a non-antibiotic antibacterial agent that is bactericidal against P. acnes and has the distinct advantage that thus far, no resistance has been detected against it. Combined agents such as erythromycin/zinc, erythromycin/tretinoin, erythromycin/isotretinoin, erythromycin/benzoyl peroxide, and clindamycin/benzoyl peroxide are increasingly being used and have been proven to be effective. They generally demonstrate good overall tolerability and are useful in reducing the development of antibacterial resistance in P. acnes. The selection of a topical antibacterial agent should be tailored for specific patients by choosing an agent that matches the patient’s skin characteristics and acne type. Topical antibacterial agents should generally not be used for extended periods beyond 3 months, and topical antibacterials should ideally not be combined with systemic antibacterial therapy for acne; in particular, the use of topical and systemic antibacterials is to be avoided as far as possible.
Acne vulgaris is a very common disorder, affecting virtually every adolescent at some point in time. Systemic antibacterials have been used in the treatment of acne for many years, and there are several commonly used antibacterials which have established efficacy and safety records. In recent years, the issue of antibacterials resistance has become more prominent, especially with concerns that Propionibacterium acnes can transfer antibacterials resistance to other bacteria within the resident skin flora.
Commonly used antibacterials include tetracycline, doxycycline, minocycline, erythromycin (and other macrolides) and trimethoprim/sulfamethoxazole (cotrimoxazole). The choice of antibacterial should take into account efficacy, cost-effectiveness, benefit-risk ratios, patient acceptability and the potential for the development of resistance.
Poor clinical response can be the result of poor compliance, inadequate duration of therapy, development of gram-negative folliculitis, resistance of P. acnes to the antibacterial(s) administered, or a high sebum excretion rate.
In order to help prevent the development of resistance a number of measures should be undertaken: antibacterials are prescribed for an average of 6 months; if retreatment is required, utilize the same antibacterial; generally, antibacterials should be given for at least 2 months before considering switching due to poor therapeutic response; concomitant use of oral and topical chemically-dissimilar antibacterials should be avoided (try benzoyl peroxide and/or retinoids instead) and systemic isotretinoin should be considered if several antibacterials have been tried without success.
Purpose: To evaluate the quality of studies about drugs and food interactions with warfarin and their clinical relevance. • Data Sources: MEDLINE and TOXLINE databases from 1966 to October 1993 using the Medical Subject Headings warfarin, drug interactions, and English only. • Study Selection: All articles reporting original data on drug and food interactions with warfarin. • Data Extraction: Each report, rated independently by at least two investigators (using causality assessment), received a summary score indicating the level of assur ance (level 1 = highly probable, level 2 = probable, level 3 = possible, and level 4 = doubtful) that a clini cally important interaction had or had not occurred. Inter-rater agreement was assessed using a weighted kappa statistic. • Results: Of 793 retrieved citations, 120 contained original reports on 186 interactions. The weighted kappa statistic was 0.67, representing substantial agreement. Of 86 different drugs and foods appraised, 43 had level 1 evidence. Of these, 26 drugs and foods did interact with warfarin. Warfarin's anticoagulant ef fect was potentiated by 6 antibiotics (cotrimoxazole, erythromycin, fluconazole, isoniazid, metronidazole, and miconazole); 5 cardiac drugs (amiodarone, clofibrate, propafenone, propranolol, and sulfinpyrazone); phenylbutazone; piroxicam; alcohol (only with concom itant liver disease); cimetidine; and omeprazole. Three patients had a hemorrhage at the time of a potentiating interaction (caused by alcohol, isoniazid, and phenyl butazone). Warfarin's anticoagulant effect was inhibited by 3 antibiotics (griseofulvin, rifampin, and nafcillin); 3 drugs active on the central nervous system (barbitu
The presence of 5α-reductase (5α-R) in skin may indicate that the androgen regulation of sebaceous glands and sebum production requires the local conversion of testosterone to dihydrotestosterone. The goals of this study were to identify which isozyme of 5α-R (type 1 or type 2) is expressed in sebaceous glands from facial areas, scalp, and non-acne-prone areas; to determine if 5α-R activity is concentrated in sebaceous glands; to assess whether there are regional differences in this enzyme's activity; and to test the effects of azasteroid inhibitors and 13-cis retinoic acid on 5α-R in these tissues. Sebaceous glands were microdissected from facial skin, scalp, and non-acne-prone skin (arm, breast, abdomen, leg), and the activity of 5α-R was determined. A total of 49 samples from 23 male and 21 female subjects without acne (age range, 16 to 81 years, 56 ± 20 years [mean ± SD]) was analyzed. The biochemical properties of the enzyme in each of the samples tested are consistent with those of the type 1 5α-R. Minimal to no type 2 5α-R was detected. The level of 5α-R activity was significantly higher in the sebaceous glands compared to whole skin in facial skin (p = 0.047), scalp (p = 0.039), and non-acne-prone skin (p = 0.04). Enzyme activity in sebaceous glands from facial skin and scalp was significantly higher than in a comparable amount of sebaceous gland material obtained from non-acne-prone areas (32 ± 6 [mean ± SEM]), 35 ± 7 (mean ± SEM) versus 6.0 ± 3.0 (mean ± SEM) pmol/min/mg protein, p = 0.014 and 0.007, respectively). Finasteride and 13-cis retinoic acid were poor inhibitors of the enzyme with 50% inhibitory concentration values greater than 500 nM. These data demonstrate that in the skin from older patients without acne the type 1 isozyme of 5α-R predominates, its activity is concentrated in sebaceous glands and is significantly higher in sebaceous glands from the face and scalp compared to non-acne-prone areas, and the action of 13-cis retinoic acid in the control of acne is not at the level of 5α-R. Furthermore, we suggest that specific inhibition of the type 1 5α-R may offer a viable approach to the management of sebum production and, hence, acne.
Propionibacterium species were quantified on the foreheads and cheeks of persons with and without acne in three age groups: 11 to 15, 16 to 20, and 21 to 25. Propionibacteria were virtually absent in the pubertal non-acne group compared to a geometric mean density of 114,800 per sq cm in the acne group. A similar sharp difference existed between the acne subjects and normals in the age range of 16 to 20 years: 85,800 organisms per sq cm compared to 588 per sq cm. Patients with acne and normal subjects over age 21 showed no difference in Propionibacterium levels. In acne patients, while there was a trend for lower levels, no significant difference was seen as the severity of inflammation increased.
Background Acne is not uncommon in the neonatal period. Acne neonatorum is characterized by a mainly facial eruption of inflammatory and noninflammatory lesions. It is most commonly mild and transient. Hyperactivity of sebaceous glands, stimulated by neonatal androgens, has been implicated as the underlying pathogenetic mechanism.
Materials and methods All patients diagnosed with acne neonatorum in “A. Sygros” Hospital, Athens, Greece, during the years 1993–1996, were evaluated clinically and epidemiologically. Histologic examination and smears for Propionibacterium acnes and Pityrosporum ovale were performed in selected cases.
Results Of the 22 patients studied, 18 were male (81.8%) and 4 were female. The mean age at onset was 3 weeks and the mean duration of the disease was 4 months. Papules and pustules were the most frequent types of lesions (72.7%), followed by comedones only (22.7%). The cheeks were the most common site of predilection (81.8%). A family history of acne was reported in only three patients. Histologic examination showed hyperplastic sebaceous glands with keratin-plugged orifices. Smears for P. ovale were negative.
Conclusions Our findings are consistent with previous experience, although inflammatory lesions were encountered more often than previously reported. Hereditary factors did not seem to play a significant role in our series. Topical treatment hastened the resolution of this self-limited condition. Recalcitrant cases warrant investigation for underlying androgen excess.
Women in the second half of pregnancy, who were infected with genital mycoplasmas and who gave written informed consent, were randomly assigned to receive capsules of identical appearance containing erythromycin estolate, clindamycin hydrochloride, or a placebo for 6 weeks. Levels of serum glutamic oxalacetic transaminase (SGOT) were determined before and during treatment by a fluorometric method. All pretreatment levels of SGOT were normal (<41 units). Participants who received erythromycin estolate had significantly more abnormally elevated levels of SGOT (16/161, 9.9%) than did those who received clindamycin (4/168, 2.4%, P < 0.01) or those who received placebo (3/165, 1.8%, P < 0.01). Elevated levels of SGOT ranged from 44 to 130 U. Serum bilirubin levels were normal. Gamma-glutamyl transpeptidase activity was abnormal in six of six participants who had abnormal levels of SGOT while receiving erythromycin estolate. There were few associated symptoms, and all levels of SGOT returned to normal after cessation of treatment. The treatment of pregnant women with erythromycin estolate may be inadvisable.
Measurements were made of the proportions of octadeca-5,8-dienoic acid and octadeca-9,12-dienoic acid in the scalp surface lipids of 6 normal subjects, 5 subjects with slight acne, and 9 subjects with severe acne. The group averages for the delta5,8 isomer were: 0.74, 0.85, and 0.61% and for the delta9,12 isomer were 0.56, 0.27, and 0.19%, respectively. The differences in the levels of the delta9,12 isomer between the normal subjects and the groups with slight and with severe acne were statistically significant (p less than 0.02 and 0.001), respectively) but there was no significant difference in the content of the delta5,8 compound. The ratio of the delta5,8/delta9,12 isomers showed no correlation with the rate of sebum production in 12 subjects.
42 patients with acne vulgaris, clinically resistant to prior therapy with tetracyclines, were evaluated after therapy with sulphamethoxazole-trimethoprim (400 + 80 mg) twice daily. Initially and after 6, 12 and 18 weeks of treatment in each patient the different acne lesions were counted and pus specimens from unhealed pustules were taken for bacteriological analysis. Complete remission or excellent results were obtained in 33 patients (79%) at the end of treatment despite a relative increase of Staphylococcus hominis and Propionibacterium granulosum. These species were more resistant in agar dilution test to the combination sulphamethoxazole-trimethoprim (20:1) than other isolated species.
One hundred three patients with acne vulgaris were randomly designated to receive either a topical formulation of erythromycin plus zinc or a topical solution of 1% clindamycin phosphate (Cleocin-T). The patients treated themselves twice daily and were examined at 3, 6, 9, and 12 weeks after the start of therapy. By week 6 the overall severity grade was consistently lower and the percent reduction of severity, papules, pustules, and total comedones was higher in the erythromycin-zinc-treated group than in the clindamycin-treated group. In the 92 patients who completed this study (48 receiving erythromycin-zinc and 44 receiving clindamycin), no serious topical or systemic side effects were reported. Two patients, one from each treatment group, suffered mild irritation. One patient was withdrawn from the erythromycin-zinc-treated group. Results of patch tests were negative. The superiority of the erythromycin-zinc formulation may be due to the increased (4%) erythromycin concentration and/or the ability of 1.2% zinc acetate to enhance the product's activity.
Acute theophylline toxicity is usually due to overdose. However, it may also be brought about by interference of its metabolism secondary to the concurrent administration of other drugs. Erythromycin is important in this regard as illustrated in the following case of a 16-year-old girl who developed theophylline toxicity while on therapy with both of these drugs. As well as the potential for theophylline toxicity, coadministration of these two drugs may result in subtherapeutic serum erythromycin concentrations. Thus, if at all possible, this practice should be avoided. If unavoidable, then serial serum theophylline concentrations should be monitored. The occurrence of this interaction is unpredictable. Thus the previous recommendation of decreasing the theophylline dosage by 25% to prevent toxicity during erythromycin therapy is irrational and should be avoided. Drug interactions should be considered in the differential diagnosis of theophylline toxicity.
The efficacy of erythromycin base (E-Mycin tablets, 333 mg) and the efficacy of tetracycline hydrochloride (Panmycin tablets) were compared in this double-blind, randomized study. Two hundred patients with moderate to moderately severe acne vulgaris were randomly assigned to the study. One hundred patients received 1 gm of erythromycin base by mouth per day for 4 weeks, followed by 333 mg/day for 8 weeks, plus placebo for tetracycline. The second group of patients received 1 gm of tetracycline by mouth per day for 4 weeks, followed by 500 mg/day for 8 weeks, plus placebo for erythromycin. Both drugs reduced acne severity to the same extent. Pustules, papules, and open comedo counts decreased significantly over the 12-week period. Seventy-seven percent of the erythromycin-treated patients and 89% of the tetracycline-treated patients stated that their acne was markedly improved or improved by week 12. Most of the side effects in patients treated with erythromycin were gastrointestinal symptoms. Among the side effects in patients treated with tetracycline were Candida vaginitis in one patient and pseudotumor cerebri in one patient.
Pseudomembranous colitis was observed on two occasions in the same patient and was associated with the topical administration of clindamycin phosphate. Assay for Clostridium difficile toxin was positive, and the patient was ultimately cured by oral vancomycin hydrochloride and the withdrawal of clindamycin therapy.
A 12–week, observer-blind, study compared doxycycline (50 mg daily) with minocycline (50 mg twice daily) in the treatment of acne vulgaris in 4.1 patients. The analysis of data on 34 patients completing the study (15 receiving doxycycline and 19 receiving minocycline) showed both treatments to be equally effective, although the use of doxycycline had the advantage of it being a once-daily treatment regime. Doxycycline, with minimal side effects, can be recommended for the treatment of acne vulgaris.
Because of significant and seemingly haphazard fluctuations in serum carbamazepine concentrations, we decided to investigate the possible link between erythromycin administration and potential changes in serum carbamazepine concentration. We studied four cases involving this combination. In every case, serum carbamazepine concentrations either rose dramatically (doubled or tripled previous steady-state concentrations) or dropped precipitously once erythromycin therapy was discontinued. In all cases, we report serum carbamazepine concentrations obtained before, during, and after concurrent erythromycin administration. We conclude that the combination of erythromycin and carbamazepine represents a clinically significant drug interaction and should be avoided where possible.
(JAMA 1986;255:1165-1167)
A case of a 57-year-old male with pigmentation of aortic and mitral valves associated with 5 years of minocycline therapy is reported. Hyper-melanosis in sun-exposed areas and deposition of blue-black pigment in sites of previous trauma also occurred. The implications of the widespread use of long-term minocycline therapy for acne in adolescents and young adults are considered.
The minimal inhibitory concentration (MIC) of Propionibacterium acnes in seventy-five acne patients receiving long-term antibiotic therapy demonstrated the emergence of resistant strains. The mean MIC in thirty-three patients receiving long-term tetracycline was four to five times higher than that found in control groups of acne patients not receiving antibiotic therapy and controls free of acne. The average MIC for erythromycin was more than 100 times higher in those receiving long-term antibiotic therapy. In a second group of sixty-two patients, the clinical course and number of P. acnes were correlated with the presence of "resistant strains" defined as P. acnes with a tenfold increase in MIC to tetracycline or erythromycin. Patients with resistant strains had higher counts of P. acnes and clinically were not doing as well as those with sensitive strains.
The effect of 1,000 mg of tetracycline hydrochloride and 200 mg of minocycline hydrochloride on Propionibacterium acnes levels and skin-surface lipid levels was measured in 15 patients with acne. Minocycline produced a significantly greater reduction in the P acnes counts that persisted even up to three weeks after discontinuation of the minocycline therapy, in contrast to the return of P acnes to baseline counts within three weeks after discontinuation of tetracycline therapy. A similar persistence of effect for reduction of skin-surface free fatty acid levels and clinical lesions was also seen with minocycline therapy.
Although many cytokines have been implicated in the development and persistence of inflammatory immune responses, it is unknown if any of these are important in inflammatory acne. This study investigated the production of the proinflammatory cytokines interleukin-8 (IL-8), IL-1 beta, and tumor necrosis factor alpha (TNF-alpha) by human monocytic cell lines, ThP-1 and U937, and by freshly isolated peripheral blood mononuclear cells from acne patients. Both Propionibacterium acnes and supernatants obtained from 72-h P. acnes cultures could induce significant concentrations of IL-1 beta, TNF-alpha, and IL-8 by both cell lines and by peripheral blood mononuclear cells as determined by enzyme-linked immunosorbent assay. There was no significant difference between acne and non-acne subjects. Endotoxin quantification and addition of polymyxin B to assays indicated no lipopolysaccharide (LPS) contamination. P. acnes supernatant was fractionated into components with molecular weights of < 3,000, < 10,000, and < 30,000 and assayed for the ability to induce IL-8 and TNF production in ThP-1 cells. Nearly 90% of the original activity was found in the < 30,000-molecular-weight fraction, 50% was in the < 10,000-molecular-weight fraction, and only 15% remained in the < 3,000-molecular-weight fraction. The effluent from the < 3,000-molecular-weight fraction contained about 70% activity, indicating that the inducing factor was not retained in the membrane. Incubation of P. acnes supernatant with various concentrations of mutanolysin or lysozyme resulted in a loss of 60% of the original activity. The addition of jimson lectin, which binds peptidoglycan, resulted in a loss of 70% of the activity in a dose-response manner, whereas peanut lectin had little or no effect on the activity. Heating of the P. acnes supernatant to 65 degrees C also had no effect on the activity. Blocking of CD14, a receptor for both LPS and peptidoglycan, reduced cytokine production by > 50%, suggesting that the soluble stimulating factor may be a secreted form of peptidoglycan-polysaccharide.
A 28-day treatment regimen was undertaken by 12 volunteers, in which 5% (w/v) benzoyl peroxide (BP) in an aqueous gel was applied daily to the entire face. Clinical efficacy of the treatment was assessed after 2, 4, 9, 14 and 28 days, and the surface and follicular microbial populations were enumerated using established techniques. Viable counts were obtained for propionibacteria and Micrococcaceae. Mean numbers of propionibacteria recovered from the skin surface and follicular casts were significantly reduced after 2 days' treatment (P < 0.01), and the population was maintained at a significantly lower level throughout the study (P < 0.01), with mean values approaching the lower detection limit of the assay. Significant reductions in the surface and follicular Micrococcaceae were observed after 2 days' treatment, and at all subsequent visits (P < 0.05). After 2 days' treatment, only slight reductions in mean acne grade and mean inflamed lesion count were observed. However, at all subsequent visits the mean acne grade was significantly reduced (P < 0.05) compared with T0. The mean non-inflamed lesion count was lower than the pretreatment level at all visits, although the results were variable. The results indicate that significant reductions in surface and follicular microorganisms may be obtained after 48 h treatment with BP. Therefore, the non-specific antibacterial action of BP may be utilized in short intervening courses to reduce the carriage of antibiotic-resistant micro-organisms and thus improve the long-term efficacy of antibiotic acne treatments.(ABSTRACT TRUNCATED AT 250 WORDS)
Topical formulations of erythromycin and benzoyl peroxide are popular and effective treatments for mild to moderate acne vulgaris. Use of the former is associated with resistance gain in both skin propionibacteria and coagulase-negative staphylococci, whereas use of the latter is not. We evaluated the efficacy of a combination of erythromycin and benzoyl peroxide against a total of 40 erythromycin-sensitive and -resistant strains of Staphylococcus epidermidis and skin propionibacteria in vitro. Using the checkerboard technique, five erythromycin resistant strains of Propionibacterium acnes were inhibited synergistically or additively by the combination. Complete mutual indifference was exhibited between the drugs against the remaining 35 strains. However, erythromycin resistant staphylococci and propionibacteria were inhibited by the same concentration of benzoyl peroxide as erythromycin-sensitive strains. These results suggest that, although the combination of erythromycin and benzoyl peroxide is not synergistic against the majority of erythromycin-resistant staphylococci and propionibacteria, the concomitant therapeutic use of both drugs should counteract the selection of erythromycin-resistant variants and reduce the number of pre-existing resistant organisms on the skin of acne patients.
To evaluate the quality of studies about drugs and food interactions with warfarin and their clinical relevance.
MEDLINE and TOXLINE databases from 1966 to October 1993 using the Medical Subject Headings warfarin, drug interactions, and English only.
All articles reporting original data on drug and food interactions with warfarin.
Each report, rated independently by at least two investigators (using causality assessment), received a summary score indicating the level of assurance (level 1 = highly probable, level 2 = probable, level 3 = possible, and level 4 = doubtful) that a clinically important interaction had or had not occurred. Inter-rater agreement was assessed using a weighted kappa statistic.
Of 793 retrieved citations, 120 contained original reports on 186 interactions. The weighted kappa statistic was 0.67, representing substantial agreement. Of 86 different drugs and foods appraised, 43 had level 1 evidence. Of these, 26 drugs and foods did interact with warfarin. Warfarin's anticoagulant effect was potentiated by 6 antibiotics (cotrimoxazole, erythromycin, fluconazole, isoniazid, metronidazole, and miconazole); 5 cardiac drugs (amiodarone, clofibrate, propafenone, propranolol, and sulfinpyrazone); phenylbutazone; piroxicam; alcohol (only with concomitant liver disease); cimetidine; and omeprazole. Three patients had a hemorrhage at the time of a potentiating interaction (caused by alcohol, isoniazid, and phenylbutazone). Warfarin's anticoagulant effect was inhibited by 3 antibiotics (griseofulvin, rifampin, and nafcillin); 3 drugs active on the central nervous system (barbiturates, carbamazepine, and chlordiazepoxide); cholestyramine; sucralfate; foods high in vitamin K; and large amounts of avocado.
Many drugs and foods interact with warfarin, including antibiotics, drugs affecting the central nervous system, and cardiac medications. Many of these drug interactions increase warfarin's anticoagulant effect.
We identified eight patients (six women and two men) who had pulmonary infiltrates during treatment with minocycline hydrochloride between 1989 and 1992 in French referral centers for drug-induced pulmonary diseases. Clinical files, chest roentgenograms, computed tomographic scans, pulmonary function, and bronchoalveolar lavage data were reviewed. Minocycline treatment was given for acne (n = 4), genital infection (n = 3), and Lyme disease (n = 1). The duration of treatment averaged 13 +/- 5 days (mean +/- SE); the total dose, 2060 +/- 540 mg. Patients presented with dyspnea (n = 8), fever (n = 7), dry cough (n = 5), hemoptysis (n = 1), chest pain (n = 2), fatigue (n = 3), and rash (n = 3). Chest roentgenograms showed bilateral infiltrates in all cases. Pulmonary function was measured in five patients; four had airflow obstruction and two had mild restriction. Blood gas tests demonstrated hypoxemia in seven patients (58 +/- 3 mmHg). Seven patients had blood eosinophilia (1.76 +/- 0.2 x 10(9)/L). Bronchoalveolar lavage (performed in seven patients) showed an increased proportion of eosinophils (0.30 +/- 0.07). The Cd4+/CD8+ ratio was determined in four cases and was low in three. Transbronchial lung biopsy, performed in two patients, showed interstitial pneumonitis in both patients, with marked infiltration by eosinophils in one patient. The outcome was favorable in all patients. Because of severe symptoms, steroid therapy was required in three patients. Rechallenge was not attempted. We conclude that minocycline can induce the syndrome of pulmonary infiltrates and eosinophilia, that presenting symptoms may be severe and may culminate in transient respiratory failure, and that the disease has a favorable prognosis.
Acne vulgaris usually improves with long-term oral antibiotic therapy; however, some patients fail or only partially respond to the commonly prescribed antibiotics. Only a proportion of these patients warrants treatment with isotretinoin suggesting a need for additional therapeutic options. We have therefore performed an open retrospective study of the efficacy of trimethoprim as a third-line antibiotic in the treatment of patients whose acne vulgaris failed to respond to at least 2 courses of antibiotics. A total of 56 patients were reviewed, who had all failed to respond adequately to a minimum of 2 courses of antibiotics. All patients received trimethoprim in a dosage of 300 mg twice daily for at least 4 months, unless it had been withdrawn due to side effects. Topically they were given 1% clindamycin lotion twice daily to the affected areas. The severity of the patient's acne was graded on the face, back and chest. The changes in acne grades were evaluated using non-parametric statistics (Wilcoxon matched pairs). At 4 months there were significant improvements from the grades at initiation in all three sites (p = 0.005 or less). Twenty-one patients remained on the treatment for 8 months, and a significant improvement in the changes of the acne grades remained (p = 0.02 or less). Two patients had the trimethoprim stopped due to side effects. We can therefore recommend this regime as a third-line treatment in the management of acne.
This article details clinical reports and studies of ototoxicity associated with the administration of erythromycin and its analogues. Suspected mechanisms of ototoxicity also are discussed. Ototoxicity due to erythromycin appears to be clearly dose related.
The tetracycline group of antibiotics still remains the most successful oral treatment for acne. They are relatively free from side-effects apart from the occasional gastrointestinal upset or vaginal candidosis. Rarer side-effects include drug rashes, pigmentation with minocycline and a light-sensitive eruption with doxycycline. The incidence of light-sensitive rashes with doxycycline at a dose of 100 mg daily, is in the order of 3%. Acne does not always respond to conventional regimens of antibiotics and higher dosages may be required. We report a highly significant incidence of light-sensitive eruptions in patients receiving doxycycline at a daily dose of 150 mg or above.
Oral mucosal pigmentation is an infrequently reported side effect of minocycline. Two patients with minocycline deposition within teeth and bone, demonstrated by fluorescence microscopy, are described. Minocycline is the only tetracycline reported to cause discoloration of the oral mucosa. This may be the result of deposition of an insoluble degradation product of minocycline in the underlying bone. Pigmentation is not necessarily dose-dependent and may take months or years to resolve.
A 65-year-old man had cutaneous hyperpigmentation that had occurred over the previous 2 1/2 years. The hyperpigmentation was extensive and involved the sclerae, nail beds, and total body; the palms and buttocks were spared. Clinical diagnosis was suggestive of hemochromatosis or heavy metal deposition. Histologic and electron microscopic findings were consistent with lysosomal iron deposition. A careful history showed that minocycline was the cause. Its use was discontinued, and after several years the patient's pigmentation is gradually returning to normal.
To estimate the risk of cholestatic hepatitis of uncertain origin in patients who had recently received erythromycin, a drug which is known to cause this disorder.
A retrospective cohort study using data automatically recorded on general practitioners' office computers.
Some 600 general practices in the United Kingdom.
366,064 people who received erythromycin.
Clinically documented cholestatic hepatitis of uncertain origin diagnosed 1-45 days after a prescription for erythromycin.
There were 13 cases of cholestatic hepatitis of uncertain origin diagnosed within 45 days of receiving erythromycin which were either characteristic of or consistent with a syndrome previously described as being associated with this drug.
The risk of cholestatic jaundice associated with erythromycin is estimated to be in the range of 3.6 per 100,000 users (95% confidence interval, 1.9-6.1).
Antibiotic-resistant propionibacteria are being isolated with increasing frequency from antibiotic-treated acne patients. Minimum inhibitory concentrations (MICs) of three tetracyclines, extensively used in acne therapy, were determined for 46 resistant and 19 sensitive propionibacteria isolates. Sensitive strains were inhibited by < or = 1 microgram/ml of all three tetracyclines. For every resistant strain tested, the MIC of tetracycline exceeded that of doxycycline which, in turn, exceeded that of minocycline. The mean MIC for resistant strains was 20.61 +/- 4.56 micrograms/ml of tetracycline, 9.70 +/- 2.03 micrograms/ml of doxycycline and 1.95 +/- 0.35 micrograms/ml of minocycline. In order to determine whether these strains could be inhibited by concentrations of minocycline achievable in vivo, serum levels of minocycline were determined in acne patients receiving either the recommended dose of 50 mg b.d. (20 males, 14 females), or twice this dose (21 males, 12 females). Serum levels were significantly higher (P < 0.001, Student's t-test) in patients receiving 100 mg b.d. Males on 50 mg b.d. had significantly lower serum levels than females on the same dose (P < 0.05. Student's t-test). For all patients, the mean serum level on high-dose minocycline was 2.46 +/- 0.45 micrograms/ml, compared with 1.38 +/- 0.30 micrograms/ml on the smaller dose. These results indicate that tetracycline-resistant propionibacteria should be considered clinically minocycline sensitive, if patients who harbour such strains are prescribed 100 mg b.d. The recommended dose of minocycline for treating acne, especially in male patients, should be re-assessed.
To help elucidate the factors responsible for the infundibular changes seen in acne, the human sebaceous pilosebaceous infundibulum was isolated by microdissection and maintained for 7 d in keratinocyte serum-free medium supplemented with 50 micrograms/ml bovine pituitary extract, 100 units/ml penicillin and streptomycin, 2.5 micrograms/ml amphotericin B and CaCl2(10H2O) to give a final Ca2+ concentration of 2 mM. Infundibular structure was maintained over 7 d in this medium; the pattern of cell division mimicked that in vivo. The rate of cell division was significantly higher than previously described for infundibula maintained in supplemented William's E medium, and moreover did not fall over 7 d. The addition of 1 ng/ml interleukin-1 alpha (IL-1 alpha) caused hypercornification of the infundibulum similar to that seen in comedones; this could be blocked by 1000 ng/ml interleukin-1 receptor antagonist (IL-1ra). In about 20% of subjects there was spontaneous hypercornification of the infundibulum that could be blocked by 1000 ng/ml IL-1ra, suggesting that the infundibulum is capable of synthesising IL-1 alpha. The addition of 5 ng/ml epidermal growth factor or 5 ng/ml transforming growth factor-alpha to the medium caused a disorganisation of the keratinocytes of the infundibulum that resulted in rupturing similar to that seen in the more severe, purulent grades of acne. The addition of 1 microM 13-cis retinoic acid caused a significant reduction in the rate of DNA synthesis and apparent parakeratosis. We are now, therefore, able to model histologically the major infundibular changes in acne.
Pancreatitis due to ingestion of erythromycin is rare.
A 20-year-old woman took erythromycin 3 g and acetaminophen 6 g before a tooth extraction. Forty minutes later, she experienced severe abdominal pain, nausea, and vomiting. The serum amylase and lipase were elevated. She recovered from the pancreatitis without sequelae after supportive treatment.
This is the fourth reported case of erythromycin-induced acute pancreatitis in the English literature.
Minocycline is widely used as a second-line antimicrobial for acne vulgaris. Some patients require doses of up to 200 mg daily to control their acne. To assess the long-term safety of minocycline when used at higher doses, 700 patients treated with minocycline at doses of 100 mg daily, 100/200 mg on alternate days and 200 mg daily, were recruited. The mean duration of treatment was 10.5 months. Side-effects were monitored and full blood count, blood urea, electrolytes and liver function tests were carried out on 200 of the 700 patients. Side-effects were recorded in 13.6%, and included vestibular disturbance, candida infection, gastrointestinal disturbance, cutaneous symptoms (pigmentation, pruritus, photosensitive rash and urticaria) and benign intracranial hypertension. Pigmentation was the only side-effect found to be significantly increased in patients taking higher doses of minocycline, as compared with lower doses (P < 0.01). All patients with pigmentation had taken a total cumulative dose of over 70 g. No significant abnormalities were found in any of the haematological and biochemical profiles. We conclude that minocycline, at doses of up to 200 mg/day, is safe, long-term, for acne, when such doses are clinically necessary.
Concomitant application of 5% w/w benzoyl peroxide and 3% w/w erythromycin has previously been shown to prevent the overgrowth, on the skin of acne patients, of erythromycin-resistant coagulase-negative staphylococci, which occurs when the antibiotic is used alone. Two in vivo studies were carried out to assess the ability of the same therapeutic combination to inhibit the growth of pre-existing erythromycin-resistant propionibacteria and to prevent the selection of resistant strains during treatment. A double-blind clinical trial in 37 patients with mild to moderate acne vulgaris showed that the combination brought about a > 3 log10 c.f.u. reduction in total propionibacterial numbers/cm2 after 6 weeks therapy (P < 0.001, Wilcoxon's matched pairs) and also significantly reduced the number of erythromycin-resistant propionibacteria (P < 0.05). In contrast, erythromycin alone reduced the total propionibacterial count by < 1.5 log10 c.f.u./cm2 after 6 weeks (P < 0.05) and did not affect the number of erythromycin-resistant strains. The combined formulation was significantly more effective at reducing total propionibacterial numbers at 6 (P < 0.01, Mann-Whitney) and 12 weeks (P < 0.05) than erythromycin alone, although, after 12 weeks, the anti-propionibacterial efficacy of both preparations was less marked. Five patients on combination therapy, and five treated with erythromycin alone, acquired erythromycin-resistant strains de novo at week 6 or week 12. In an open study in 21 acne patients, who each carried > 10(3) c.f.u. erythromycin-resistant propionibacteria/cm2 skin pretreatment, the combination of erythromycin and benzoyl peroxide reduced the total propionibacterial count by > 2.5 log10 and the number of erythromycin-resistant strains by a similar amount (P < 0.001, Wilcoxon). This was accompanied by highly significant reductions in acne grade and lesion counts (P < 0.001). These data suggest that the combination of 5% w/w benzoyl peroxide and 3% w/w erythromycin has greater in vivo anti-propionibacterial activity than 3% w/w erythromycin alone, and brings about significant clinical improvement in acne patients with high numbers of erythromycin-resistant propionibacterial strains pretreatment.
Oral and topical antibiotics play a major role in acne therapy. Physicians base treatment choices on personal perceptions of efficacy, cost-effectiveness or risk-benefit ratios and rarely take bacterial resistance into account. Propionibacterium acnes isolates resistant to one or more anti-acne antibiotics have been reported in Europe, the USA, Japan and New Zealand. Therapeutic failure on some but not all antibiotic regimens is an increasing management problem. In Leeds, UK, resistant strains are found in 60% of acne patients and 50% of close contacts. Recommendations for the use of antibiotics in acne therapy to help prevent the emergence of resistance in P. acnes include the implementation of antibiotic usage policies and the encouragement of improved prescribing habits. Strategies to reduce the resistant P. acnes population are necessary. This paper reports preliminary data demonstrating that oral isotretinoin (Roaccutane/Accutane) significantly reduces total numbers of resistant P. acnes on the skin of all patients.
The impact of acne on quality of life can be profound. Although treatment improves the clinical features of acne, there is little information on its benefit from the patients' point of view. In this study, patients with acne referred to a dermatology clinic were sent questionnaires before being seen, and 4 and 12 months afterwards. Clinical severity was assessed by a dermatologist at baseline and at 4 months. Quality of life was assessed by patients using the Short Form 36 instrument (SF-36), the Dermatology Life Quality Index (DLQI), Rosenberg's measure of self-esteem and the General Health Questionnaire (GHQ-28). Of 90 available patients, 79 (89%) returned at least one follow-up questionnaire. The clinical acne grade improved substantially with treatment. There were also significant improvements either at 4 or 12 months in the DLQI, self-esteem. GHQ-28 and all five dimensions of the SF-36 that were impaired at baseline. Quality of life continued to improve between the 4- and 12-month follow-up questionnaires. Clinical and patient-assessed outcomes were significantly better in patients treated with isotretinoin. The study showed that disability caused by acne can be largely reversed by effective treatment. It also showed that patient-assessed measures of outcome can respond to changes over time and discriminate between treatments differing in effectiveness.
Minocycline, a second-generation cycline, has a good tissue diffusion, especially in the lung [1]. Efficiency of minocycline has been demonstrated in acne vulgaris. It reduces the level of cutaneous surface lipids and is active against Propionibacterium acnes. Furthermore, an anticomedo effect of minocycline has recently been found. It might be assumed that significant concentrations of minocycline would be present in sebaceous follicles. However, minocycline has only been found in cutaneous surface lipids and not in the sebum [2, 3]. The purpose of the study was to investigate the comedonal diffusion of minocycline in acne volunteers, using high-performance liquid chromatography (HPLC).
Antibiotic therapy for acne is very common. Antibiotics are frequently used in acne, either systemically or topically. Systemic antibiotics are indicated as treatment of moderate and quite severe acne or if acne is considered as very serious by the patient for psychological or social reasons. Results are very often excellent, but failure is possible; in this case using another treatment, especially isotretinoin, is necessary. A few antibiotics are useful: tetracyclines (tetracycline, doxycycline, minocycline, lymecycline), erythromycin, co-trimoxazole and trimethoprim. Their side effects are reviewed. During pregnancy the best antibiotic is erythromycin. For the nursing mother it is generally said that tetracyclines are contraindicated but the risks if they exist are certainly slight. The mechanism of action of systemic antibiotics for acne is not perfectly clear as it is not only antimicrobial: they diminish chemotaxis of polymorphonuclear leukocytes, modify the complement pathways and inhibit the polymorphonuclear leukocyte chemotactic factor and the lipase production in Propionibacterium acnes.
Antibiotics play a major role in acne therapy. Physicians base treatment choices on personal perceptions of efficacy, cost-effectiveness or risk-benefit ratios and rarely take bacterial resistance into account. It is well documented that resistant strains of coagulase-negative staphylococci within the resident skin flora increase in both prevalence and population density as duration of therapy increases. Acne patients represent a considerable reservoir of resistant strains of these important nosocomial pathogens which can be transferred to close contacts. Resistance in cutaneous propionibacteria has received scant attention in view of the central role of Propionibacterium acnes in inflammatory acne. Isolates resistant to one or more anti-acne antibiotics (most commonly erythromycin) have been reported in Europe, the USA, Japan and New Zealand. Carriage of resistant strains results in therapeutic failure of some but not all antibiotic regimens. In our region, skin carriage of resistant strains by 60% of acne patients and 1 in 2 of their close contacts suggests that resistant strains are widely disseminated. We are beginning to gain an understanding of those factors which encourage resistance development and can identify those patients most likely to possess resistant propionibacterial floras. Recommendations for the use of antibiotics in acne therapy to help prevent the emergence of resistance in P. acnes include the implementation of antibiotic usage policies and the encouragement of improved prescribing habits.
To document changes in the prevalence of resistance of Propionibacterium acnes to antibiotics used for treating acne.
MEDLINE and EMBASE were searched for publications on P. acnes resistance to systemic antibiotics. The search strategy mapped "acne" or "acne vulgaris" with the terms "antibiotic resistance" or "drug resistance, microbial". Only papers published in English during 1976 to 1997 were included in the search.
53 publications met the search criteria. The search output was refined by selecting papers that specifically addressed P. acnes resistance patterns. Additional studies (not included in the search output) were identified from review articles and references of the retrieved articles. Twelve articles were reviewed.
Data on the prevalence of antibiotic-resistant propionibacteria, the incidence of individual resistance phenotypes, mixed resistance, and correlation between poor therapeutic response and resistant propionibacteria were extracted.
Research since 1978 has suggested an association between poor therapeutic response and antibiotic-resistant propionibacteria. The overall incidence of P. acnes antibiotic resistance has increased from 20% in 1978 to 62% in 1996. Resistance to specific antibiotics varied and was most commonly reported with erythromycin and clindamycin, tetracycline and doxcycline, and trimethoprim. Resistance to minocycline is rare.
In many patients with acne, continued treatment with antibiotics can be inappropriate or ineffective. It is important to recognise therapeutic failure and alter treatment accordingly. The use of long-term rotational antibiotics is outdated and will only exacerbate antibiotic resistance.
Successful management of acne requires careful patient evaluation followed by consideration of several patient and medication factors when selecting a particular therapeutic regimen. Within the last few years, several new agents for the treatment of acne have become available that afford greater flexibility in the treatment of this prevalent dermatologic disorder. These include adapalene, tazarotene, 2 new topical tretinoin formulations, azelaic acid, a new sodium sulfacetamide formulation, and an oral contraceptive recently approved by the Food and Drug Administration for the treatment of acne. After a brief overview of the pathophysiology of acne and existing therapies, this review evaluates the new antiacne agents and how they can be integrated into a successful treatment strategy that takes into account acne severity and predominant lesion type as well as age, skin type, lifestyle, motivation, and the presence of coexisting conditions.
Minocycline has increasingly been associated with different adverse auto-immune reactions including drug-induced lupus. Objective: To identify the scope of minocycline-induced lupus and to characterise its typical features.
Comprehensive Medline and Embase search of the English and non-English literature for case reports of minocycline-induced lupus.
We included 57 cases of minocycline-induced lupus (mean age +/- SD at onset: 21.6+/-8.6 years, median time of exposure: 19 months, range 3 days to 6 years). All patients showed the clinical features of polyarthralgia/polyarthritis often accompanied by liver abnormalities. Twelve patients had evidence of dermatological manifestations (i.e rash, livedo reticularis, oral ulceration, subcutaneous nodules, alopecia). The ANA test was positive in all patients.
Long-term exposure to minocycline may be associated with drug-induced lupus. Baseline and periodic liver function and ANA tests accompanied by appropriate clinical monitoring are suggested for patients receiving long-term minocycline therapy.
To study the minimum inhibitory concentrations (MICs) of Propionibacterium acnes (P. acnes) isolates to selected antibiotics from patients with acne vulgaris in Singapore and determine if resistance increases with prolonged use of antibiotics.
A single-centre prospective study.
Tertiary dermatological referral centre in Singapore.
One hundred and fifty patients with acne vulgaris seen at the National Skin Centre.
In patients who had never been on antibiotics, there were no resistant isolates of P. acnes. In patients who had been on short-term antibiotics (between 6 to 18 weeks), there were 2 resistant strains among the 34 isolates (6.25%); in patients who had been on antibiotics for longer periods, there were 11 resistant strains among the 51 isolates (21.6%). The differences in the rates of isolation of resistant strains between patients who had not been on antibiotics to those that had been on long-term antibiotics were statistically significant (P = 0.015). There was also a significant difference in isolation of resistant strains from those on short-term antibiotics compared to those who had been on long-term antibiotics (P = 0.036). Resistance to erythromycin was most commonly encountered. Most of the erythromycin-resistant strains also showed cross-resistance to clindamycin. The average MICs to antibiotics such as minocycline, erythromycin and clindamycin in those on long-term antibiotics were significantly higher when compared to patients who had not been on antibiotics.
Antibiotic resistance in P. acnes isolates in Singapore follows similar patterns to studies conducted in Europe. Resistance to erythromycin was most commonly seen, and this is associated with cross-resistance to clindamycin. Among the tetracycline group of drugs, the average MICs to tetracycline was higher than that for doxycycline, which in turn was higher than that for minocycline. Antibiotic resistance can occur with short-term antibiotic courses, and the rate of resistance increases as the duration of antibiotic consumption increases.