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Antibiotic stewardship: The need to reduce antibiotics in acne treatment
Author(s) -
Gollnick Harald P. M.,
Buer Jan,
Beissert Stefan,
Sunderkätter Cord
Publication year - 2016
Publication title -
jddg: journal der deutschen dermatologischen gesellschaft
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 60
eISSN - 1610-0387
pISSN - 1610-0379
DOI - 10.1111/ddg.13048_e
Subject(s) - antibiotics , propionibacterium acnes , acne , medicine , tetracycline , antibiotic resistance , benzoyl peroxide , antibiotic stewardship , dermatology , intensive care medicine , microbiology and biotechnology , biology , polymer , chemistry , organic chemistry , polymerization
Summary 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.