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| |  Topical Antibiotics for ACNE Losing Battle Against Bacterial Resistance WASHINGTON, Feb. 14, 1996 -- Medical experts today warned that the growing problem of bacterial resistance has spread beyond systemic antibiotics to include some of the topical antibiotic medications widely used to treat acne. Bacterial resistance is diminishing the effectiveness of current acne therapies and threatens to limit the options available to heal the most common skin condition diagnosed and treated by physicians, according to Professor William J. Cunliffe, director of the Skin Research Center at the University of Leeds in England. "By the year 2000, dermatologists worldwide may have few, if any, antimicrobial agents to rely on to treat their acne patients," Dr. Cunliffe said in addressing a national meeting of dermatologists here. A study conducted by Dr. Cunliffe and his colleagues at Leeds revealed that acne-causing bacteria, called Propionibacterium acnes (P. acnes), have developed strains that resist treatment by both systemic and topical forms of erythromycin when this antibiotic is used alone. Erythromycin is the active ingredient in many prescription acne medications. Most of those strains also resist treatment by clindamycin, another topical antibiotic commonly used to treat acne. The study was published in the January 1996 issue of the British Journal of Dermatology. "We're running out of options," said Dr. James Leyden, a professor of dermatology at the University of Pennsylvania School of Medicine. "We estimate that at least one out of four acne patients have some strains of P. acnes which are resistant to tetracycline, erythromycin and clindamycin and are less sensitive to minocycline and doxycycline than in the past. The clinical significance is not entirely clear in those who have small numbers of resistant strains, but can be associated with treatment failure in those with high numbers of resistant P. acnes." Combination Therapy Has Advantages The Leeds study demonstrated that one important strategy for addressing resistance is to use combination therapy, such as the topical medication Benzamycin, which contains both benzoyl peroxide (an antibacterial) and erythromycin. Unlike using an antibiotic alone, the synergistic effect of combination therapy with Benzamycin prevents more resistant bacteria from growing during treatment. The benzoyl peroxide kills the resistant bacteria, as well as other, susceptible acne-causing bacteria. This action allows the erythromycin to both target sensitive bacterial strains and effectively treat the actual inflammation. "The advantage we have seen with using benzoyl peroxide and erythromycin together is that the combination produces clinical improvement in patients who carry high numbers of resistant P. acnes," said Dr. Cunliffe. Dr. Cunliffe has found that when the combination of benzoyl peroxide and erythromycin is used, less erythromycin is needed to prevent the growth of resistant bacteria, compared to the amount needed when erythromycin is used alone.(1) Another study conducted by Dr. Leyden and colleagues at the University of Pennsylvania School of Medicine found that use of benzoyl peroxide or the combination of erythromycin and benzoyl peroxide in treating acne significantly reduced the number of antibiotic-resistant staphylococci, an important pathogen in hospital-acquired infections. Resistant staphylococci can have potentially serious medical health consequences for patients, particularly coagulese-negative strains such as S. epidermidis, which have been found to spread disease in newborn infants, surgical patients and patients with indwelling catheters. Antibiotic Resistance in Acne Treatment is a Global Problem The Leeds study confirms a problem demonstrated in previous research. An earlier study of 204 acne patients found that those treated with oral erythromycin or topical clindamycin developed resistant bacteria. In another study, 30 men with acne were treated for four weeks with topical erythromycin. The percentage of patients with erythromycin-resistant bacteria increased from three percent before treatment to 60 percent after treatment. According to Dr. Cunliffe, antibiotic-resistant P. acnes have been reported in the United Kingdom, Germany, France and Japan as well as the U.S. Key factors in the emergence of antibiotic-resistant P. acnes, according to Dr. Cunliffe, are poor patient compliance, protracted use of antibiotic therapy, inadequate doses of therapy and previous treatment with different antibiotics. Dr. Cunliffe said that physicians can help control acne resistance by not using antibiotics unless absolutely necessary, treating patients for the minimum required period, re-using the same antibiotic whenever possible, and avoiding concomitant or sequential use of different antibiotics to reduce the risk of resistance developing to both. 17 Million People of All Ages Affected Acne is a disease of oil glands (sebaceous glands) that affects approximately 17 million people in the United States. Nearly 80 percent of the population experience acne at some point in their lives. While the condition is most prevalent among teenagers, acne affects people of all ages, from infants to the elderly. Acne develops when the glands become clogged by skin cells that block the opening of pores. If the blocked pore is closed, it forms a whitehead; if the pore is open, it forms a blackhead. Red, inflamed papules and pustules are formed when acne bacteria break through the whitehead or blackhead. The most common form of acne (acne vulgaris) is a constellation of whiteheads, blackheads, papules and pustules. Acne occurs most often on the face, but it can also develop on the back, chest, shoulders and neck. Although it is not a life threatening condition, severe acne can cause scarring and affect a patient's self-image, causing insecurity and feelings of inferiority. Research on the psychosocial ramifications of acne has shown that the condition can negatively impact a patient's social, academic and employment status. While some over-the-counter products control mild forms of acne, prescription antibiotics, both topical and oral, are sometimes needed to clear up more severe cases. Infrequently, adverse skin reactions for prescription antibiotics may include dryness, redness (erythema) and pruritus (itching). Leeds Foundation for Dermatological Research is a registered research charter committed to the research and treatment of acne, encompassing the physicians and scientists from Leeds General Infirmary and Leeds University. (1) Eady EA, et al. The effects of acne treatment with a combination of benzoyl peroxide and erythromycin on skin carriage of erythromycin-resistant propionibacteria. Br J Dermatol 1996; 134:107-113.
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