Systematic review of antibiotic resistance in acne: an increasing topical and oral threat

Summary Topical and oral antibioticsare routinely used to treat acne. However, antibioticresistance is increasing, with many countries reporting that more than 50% of Propionibacterium acnesstrains are resistant to topical macrolides, making them less effective. We reviewed the current scientific literature to enable proposal of recommendations for antibioticuse in acne treatment. References were identified through PubMed searches for articles published from January, 1954, to March 7, 2015, using four multiword searches. Ideally, benzoyl peroxidein combination with a topical retinoidshould be used instead of a topical antibioticto minimise the impact of resistance. Oral antibioticsstill have a role in the treatment of moderate-to-severe acne, but only with a topical retinoid, benzoyl peroxide, or their combination, and ideally for no longer than 3 months. To limit resistance, it is recommended that benzoyl peroxideshould always be added when long-term oral antibioticuse is deemed necessary. The benefit-to-risk ratio of long-term antibioticuse should be carefully considered and, in particular, use alone avoided where possible. There is a need to treat acne with effective alternatives to antibioticsto reduce the likelihood of resistance.