John Libbey Eurotext

European Journal of Dermatology


Antibiotic stewardship in dermatology: limiting antibiotic use in acne Volume 24, numéro 3, May-June 2014


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Vicente Torres for the Global Alliance to Improve Outcomes in Acne 8
1 Department of Dermato-Cancerology,
University of Nantes,
Nantes, France
2 Department of Dermatology,
Penn State University College of Medicine,
Hershey, Pennsylvania, USA
3 Department of Dermatology and Venereology Medical Faculty,
Magdeburg, Germany
4 Section of Dermatology,
Azienda Ospedaliera,
University of Ferrara, Italy
5 Department of Dermatology,
Johns Hopkins Medicine,
Baltimore, USA
6 Department of Dermatology,
University of Pennsylvania School of Medicine,
Pennsylvania, USA
7 Department of Dermatology,
State University of New York,
Brooklyn, New York, USA
8 Department of Dermatology,
Juarez Hospital,
Mexico City, Mexico
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Background/Objectives: Widespread use of antibiotics in all areas of medicine has led to significant problems with antimicrobial resistance, which have begun to compromise the usefulness of antibiotics. Antibiotics have long been a keystone of acne therapy. There is a large population of patients with acne and antibiotic therapy is often used for long durations; thus, acne therapy results in extensive antibiotic exposure. This article discusses the role of antibiotic therapy in acne from the perspective of how clinicians can best preserve the utility of these important drugs while providing efficacious and safe therapy for acne patients. Methods: Review of literature augmented by expert opinion when literature was sparse. Results: Antibiotic monotherapy (topical or oral) is not recommended due to the availability of clinically superior regimens. Systemic antibiotics are important for managing moderate to severe acne and should be used for a limited duration of time (3-4 months). Topical antibiotics should be paired with benzoyl peroxide to limit potential for resistance. Information gained in recent years about the pathophysiology of acne has shed light on the role of Propionibacterium acnes as well as other key pathogenic pathways such as inflammation. Conclusions: The improved understanding of acne pathogenic mechanisms can and should be applied to develop modern therapeutic approaches that are efficacious and mesh with current public health concerns.