Antibiotic Resistance Considerations of Importance to Clinical Dermatologists
Antibiotic resistance is a major health concern worldwide as the list of bacterial pathogens that are insensitive to available antibiotics continues to grow in both hospitals and outpatient communities. The slow development of newer antibiotics adds to the formidable challenge that clinicians face with treatment of infections caused by antibiotic-resistant bacteria. This article discusses important caveats related to antibiotic use in dermatology. These include understanding that both topical and oral antibiotics contribute to the emergence and spread of resistant bacteria, that antibiotic monotherapy is to be avoided for treatment of acne vulgaris, that effective treatment of rosacea does not require the use of an antibiotic, that antibiotic therapy in the management of atopic dermatitis is best limited to treatment of an active clinical infection, and that routine post-operative use of a topical antibiotic is not suggested after most office-based dermatologic procedures. By following principles of antibiotic stewardship, dermatologists are major players in the battle against antibiotic resistance.
Dreno B, Thiboutot D, Gollnick H, et al. Antibiotic stewardship in dermatology: limiting antibiotic use in acne. Eur J Dermatol. 2014;24(3):330–334.
Del Rosso JQ. Report from the scientific panel on antibiotic use in dermatology: introduction. Cutis. 2007;79(6S):6–8.
Leyden JJ, Del Rosso JQ, Webster GF. Clinical considerations in acne vulgaris and other inflammatory skin disorders: focus on antibiotic resistance. Cutis. 2007;79(suppl 6):9–25.
Woolhouse M, Farrar J. policy: An intergovernmental panel on antimicrobial resistance. Nature. 2014;509(7502):555–557.
Gould IM. Coping with antibiotic resistance: the impending crisis. Int J Antimicrob Agents. 2010;36 Suppl 3:S1–S2.
Van Boeckel TP, Gandra S, Ashok A, et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014;14(8): 742–750.
Cantón R, Bryan J. Global antimicrobial resistance: from surveillance to stewardship. part 2: stewardship initiatives. Expert Rev Anti Infect Ther. 2012;10(12):1375–1377.
Struelens MJ, Monnet D. Prevention of methicillin-resistant Staphylococcus aureus infection: is Europe winning the fight? Infect Control Hosp Epidemiol. 2010;31(Suppl 1):S42–S44.
Allerberger F, Lechner A, Wechsler-Fördös A, et al. Optimization of antibiotic use in hospitals—antimicrobial stewardship and the eU project ABS international. Chemotherapy. 2008;54(4):260–267. 17.
Get Smart About Antibiotics Week 2015. Centers for Disease Control and prevention. http://www.cdc.gov/media/dpk/ 2015/dpk-antibiotics-week-2015.html.
Leyden JJ, Del Rosso JQ, Webster GF. Clinical considerations in the treatment of acne vulgaris and other inflammatory skin disorders: a status report. Dermatol Clin. 2009;27(1):1–15.
Del Rosso JQ, Webster GF, Rosen T, et al. Status report from the Scientific Panel on Antibiotic Use in Dermatology of the American Acne and Rosacea Society Part 1: antibiotic prescribing patterns, sources of antibiotic exposure, antibiotic consumption and emergence of antibiotic resistance, impact of alterations in antibiotic prescribing, and clinical sequelae of antibiotic use. J Clin Aesthet Dermatol. 2016;9(4):18–24.
Del Rosso JQ, Gallo RL, Thiboutot D, et al. Status report from the Scientific Panel on Antibiotic Use in Dermatology of the American Acne and Rosacea Society Part 2: perspectives on antibiotic use and the microbiome and review of microbiologic effects of selected specific therapeutic agents commonly used by dermatologists. J Clin Aesthet Dermatol. 2016;9(5):11–17.
Del Rosso JQ, Rosen T, Thiboutot D, et al. Status Report from the Scientific Panel on Antibiotic Use in Dermatology of the American Acne and Rosacea Society Part 3: current perspectives on skin and soft tissue infections with emphasis on methicillin-resistant Staphylococcus aureus, commonly encountered scenarios when antibiotic use may not be needed, and concluding remarks on rational use of antibiotics in dermatology. J Clin Aesthet Dermatol. 2016;9(6):17–24.
American Acne & Rosacea Society official website: https://acneandrosacea.org
Cunliffe WJ, Holland KT, Bojar R, et al. A randomized, double-blind comparison of a clindamycin phosphate/benzoyl peroxide gel formulation and a matching clindamycin gel with respect to microbiologic activity and clinical efficacy in the topical treatment of acne vulgaris. Clin Ther. 2002;24(7):1117-1133.
Leyden JJ, Wortzman M, Baldwin EK. Antibiotic-resistant Propionibacterium acnes suppressed by a benzoyl peroxide cleanser 6%. Cutis. 2008;82(6):417–421.
Del Rosso JQ. Topical antibiotics. In: Shalita AR, Del Rosso JQ, Webster GF, eds. Acne Vulgaris. London, United Kingdom: Informa Healthcare; 2011:95–104.
Mills O, Thornsberry C, Cardin CW, et al. Bacterial resistance and therapeutic outcome following three months of topical acne therapy with 2% erythromycin gel versus its vehicle. Acta Derm Venereol. 2002;82:260–265.
Vowels BR, Feingold DS, Sloughfy C, et al. effects of topical erythromycin in ecology of aerobic cutaneous bacterial flora. Antimicrob Agents Chemother. 1996;40:598–604.
Bowe WP, Leyden JJ. Clinical implications of antibiotic resistance: risk of systemic infection from Staphylococcus and Streptococcus. In: Shalita AR, Del Rosso JQ, Webster GF, eds. Acne Vulgaris. London, United Kingdom: Informa Healthcare; 2011:125–133.
Berkowitz K, Regan JA, Greenberg E. Antibiotic resistance patterns of Group B streptococci in pregnant women. J Clin Microbiol. 1990;28(1):5-7.
Puopolo KM, Klinzing DC, Lin MP, et al. A composite transposon associated with erythromycin and clindamycin resistance in Group B Streptococcus. J Med Microbiol. 2007;56:947-955.
Leyden JJ. In vivo antibacterial effects of tretinoin/clindamycin and clindamycin alone on Propionibacterium acnes with varying clindamycin minimum inhibitory. J Drugs Dermatol. 2012;11(12):1434–1438.
Forbes BA, Schaberg DR. Transfer of resistance plasmids from Staphylococcus epidermis to Staphylococcus aureus: evidence for conjugative exchange of resistance. J Bacteriol. 1983;153(2):627-634.
Eady AE, Cove JH, Layton AM. Is antibiotic resistance in cutaneous propionibacteria clinically relevant? Implications of resistance for acne patients and prescribers. Am J Clin Dermatol. 2003;4(12):813–831.
Goossens H. Antibiotic consumption and link to resistance. Clin Microbiol Infect. 2009;15(Suppl 3):12–15.
Seppala et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial resistance. N Engl J Med. 1997;337(7): 441–446.
Bergman M, Huikko S, Pihlajamäki M, et al. effect of macrolide consumption on erythromycin resistance in Streptococcus pyogenes in Finland in 1997–2001. Clin Infect Dis. 2004;38(9):1251–1256.
Steinhoff M, Buddenkotte J, Aubert J, et al. Clinical, cellular, and molecular aspects in the pathophysiology of rosacea. J Investig Dermatol Symp Proc. 2011; 15:2–11.
Two AM, Wu W, Gallo RL, et al. Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol. 2015;72:749-758.
Schwab VD, Sulk M, Seeliger S, et al. Neurovascular and neuroimmune aspects in the pathophysiology of rosacea. J Investig Dermatol Symp Proc. 2011;15:53-62.
Del Rosso JQ. Advances in understanding and managing rosacea: part 1: connecting the dots between pathophysiological mechanisms and common clinical features of rosacea with emphasis on vascular changes and facial erythema. J Clin Aesthet Dermatol. 2012;5(3):16-25.
Yamasaki K, Gallo RL. The molecular pathology of rosacea. J Dermatol Sci. 2009;55:77-81.
Del Rosso JQ, Gallo RL, Tanghetti E, et al. An evaluation of potential correlations between pathophysiologic mechanisms, clinical manifestations, and management of rosacea. Cutis. 2013;91(3S):1-7.
Steinhoff M, Schmelz M, Schauber J. Facial erythema of rosacea – aetiology, different pathophysiologies, and treatment options. Acta Venereol. 2016;96:579-86.
Del Rosso JQ, Thiboutot D, Gallo R, et al. Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 5: a guide on the management of rosacea. Cutis.
Korting HC, Schollmann C. Tetracycline actions relevant to rosacea treatment. Skin Pharmacol Physiol. 2009;22(6):287-294.
Webster GF, Del Rosso JQ. Anti-inflammatory activity of tetracyclines. Dermatol Clin. 2007;25(2):133-135.
Del Rosso JQ. A status report on the use of sub-antimicrobial dose doxycycline: a review of athe biologic and antimicrobial effects of the tetracyclines. Cutis. 2004;74(2):118-122.
Coda AB, Hata T, Miller J, et al. Cathelicidin, kallikrein 5, and serine protease activity is inhibited during treatment of rosacea with azelaic acid 15% gel. J Am Acad Dermatol. 2013; 69:570–7.
Schaller M, Gonser L, Belge K, et al. Dual anti-inflammatory and anti-parasitic action of topical ivermectin 1% in papulopustular rosacea. J Eur Acad Dermatol Venereol. 2017 Jun 27. Doi: 10.1111/jdv.14437. [Epub ahead of print]
Casas C, Paul C, Lahfa M, et al. Quantification of Demodex folliculorum by PCR in rosacea and its relationship to skin innate immune activation. Exp Dermatol. 2012; 21:906–10.
Del Rosso JQ, Baldwin H, Webster G, et al. American Acne & Rosacea society rosacea medical management guidelines. J Drugs Dermatol. 2008;7(6):531-533.
Asai Y, Tan J, Baibergenova A, et al. Canadian clinical practice guidelines for rosacea. J Cut Med Surg. 2016;20(5):432-445.
Schaller M, Schofer H, Homey B, et al. Rosacea management: update on general measures and topical treatment options. J Dtsch Dermatol Ges. 2016;14(Suppl 6):17-27.
Mikkelsen CS, Holmgren HR, Kjellman P, et al. Rosacea: a clinical review. Dermatol Reports. 2016;8:6387.
Del Rosso JQ, Kircik LH. Update on the management of rosacea: a status report on the current role and new horizons with topical azelaic acid. J Drugs Dermatol. 2014;13(12):s101-107.
Siddiqui K, Stein Gold L, Gill J. The efficacy, safety, and tolerability of ivermectin compared with current topical treatments for the inflammatory lesions of rosacea: a network meta-analysis. Springerplus. 2016;5(1):1151.
Del Rosso JQ, et al. Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 3: a status report on systemic therapies. Cutis. 2014;93(1):18-28.
Hon KL, Tsang YC, Pong NH. Clinical features and Staphylococcus aureus colonization/infection in childhood atopic dermatitis. J Dermatolog Treat. 2016;27(3):235–240.
Hirschmann JV. When antibiotics are unnecessary. Dermatol Clin. 2009;27(1):75–83.
Breuer K, Haussler S, Kapp A, et al. Staphylococcus aureus: colonizing features and influence of an antibacterial treatment in adults with atopic dermatitis. Br J Dermatol. 2002;147(1):55–61.
Neimann AL, Lipoff J, Garner R, et al. The role of infectious agents in atopic dermatitis. In: Rudikoff D, Cohen SR, Scheinfeld N, eds. Atopic Dermatitis and Eczematous Disorders. Boca Raton, Florida: CRC Press; 2014:164–177.
Nilsson EJ, Henning CG, Magnusson J. Topical corticosteroids and Staphylococcus aureus in atopic dermatitis. J Am Acad Dermatol. 1992;27:29–34.
Stalder JF, Fleury M, Sourisse M, et al. Local steroid therapy and bacterial skin flora in atopic dermatitis. Br J Dermatol. 1994;131:536–540.
Del Rosso JQ, Levin J. The clinical relevance of maintaining the functional integrity of the stratum corneum in both healthy and disease-affected skin. J Clin Aesthet Dermatol. 2011;4(9):22–42. 49
Saco M, Howe N, Nathoo R, et al. Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis. J Dermatolog Treat. 2015;26(2):151–158.
Smack DP, Harrington AC, Dunn C, et al. Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. A randomized controlled trial. JAMA. 1996;276(12):972–977.
Dixon AJ, Dixon MP, Dixon JB. Randomized clinical trial of the effect of applying ointment to surgical wounds before occlusive dressing. Br J Surg. 2006;93(8):937–943.
Wright TI, Baddour LM, Berbari EF, et al. Antibiotic prophylaxis in dermatologic surgery: advisory statement 2008. J Am Acad Dermatol. 2008;59(3):464–473.
Abstract - 159 Full Article PDF - 108
- There are currently no refbacks.