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CLINICAL QUESTION What is the evidence for antibiotic resistance in acne, and how does
resistance affect treatment?
BOTTOM LINE Use of topical and systemic antibiotics for acne is associated with formation
of resistance in Propionibacterium acnes and other bacteria, with clinical consequences.
Guidelines recommend resistance reduction strategies including avoidance of antibiotic
monotherapy, combination treatment with topical modalities, and limiting the duration of
oral antibiotic use.
ARTICLE INFORMATION Lilly, Novartis, Sanofi, Regeneron, Pfizer, and 4. Margolis DJ, Bowe WP, Hoffstad O, Berlin JA.
Author Affiliations: Department of Dermatology, Modernizing Medicine, none relevant to this Antibiotic treatment of acne may be associated
Keck School of Medicine, University of Southern manuscript. No other disclosures are reported. with upper respiratory tract infections. Arch Dermatol.
California, Los Angeles (Adler, Armstrong); Drexel 2005;141(9):1132-1136.
University College of Medicine, Philadelphia, REFERENCES 5. Margolis DJ, Fanelli M, Kupperman E, et al.
Pennsylvania (Kornmehl). 1. Walsh TR, Efthimiou J, Drno B. Systematic Association of pharyngitis with oral antibiotic use
Corresponding Author: April W. Armstrong, MD, review of antibiotic resistance in acne: an increasing for the treatment of acne: a cross-sectional and
MPH, Department of Dermatology, Keck School of topical and oral threat. Lancet Infect Dis. 2016;16 prospective cohort study. Arch Dermatol. 2012;148
Medicine, University of Southern California, 1975 (3):e23-e33. (3):326-332.
Zonal Ave, KAM 510, MC 9034, Los Angeles, CA 2. Ross JI, Snelling AM, Carnegie E, et al. 6. Zaenglein AL, Pathy AL, Schlosser BJ, et al.
90089 (aprilarmstrong@post.harvard.edu). Antibiotic-resistant acne: lessons from Europe. Br J Guidelines of care for the management of acne
Published Online: June 21, 2017. Dermatol. 2003;148(3):467-478. vulgaris. J Am Acad Dermatol. 2016;74(5):945-73.e33.
doi:10.1001/jamadermatol.2017.1297 3. Fanelli M, Kupperman E, Lautenbach E, 7. Nast A, Drno B, Bettoli V, et al. European
Conflict of Interest Disclosures: Dr Armstrongs Edelstein PH, Margolis DJ. Antibiotics, acne, and evidence-based (S3) guideline for the treatment of
disclosures include serving as an investigator and Staphylococcus aureus colonization. Arch Dermatol. acneupdate 2016short version. J Eur Acad
consultant/advisor to AbbVie, Celgene, Janssen, 2011;147(8):917-921. Dermatol Venereol. 2016;30(8):1261-1268.