Bellevue Acne Clinic

Antibiotic Resistance in Acne Treatment

For all but the mildest acne, prescription oral medication may be part of an effective treatment plan. There are only a few types of pills in our arsenal. The most commonly used of these agents are oral antibiotics. Also available are hormonal agents (namely birth control pills and spironolactone) and Accutane.

Oral antibiotics can be very effective acne-fighting agents. The main ones used at Bellevue Acne Clinic are minocycline and doxycycline, but there are others available. Antibiotics combat acne by decreasing inflammation and killing the bacteria that contribute to acne (P. Acnes). 

A common concern about antibiotics is that they contribute to antibiotic resistance.

What is antibiotic resistance? Imagine that when you take antibiotics, you kill off 95% of the bacteria. The 5% that remain are the strongest of the original. If those “strong” bacteria are allowed to reproduce, and you kill off 95% of those bacteria, you end up with the 5% that are the “strongest strongest.” As this cycle repeats, the result can be increasingly robust bacteria that are more difficult to kill.

Although resistance is definitely a problem with medications used to fight certain infections, this is not the case for antibiotics used in acne. Why?

First, all antibiotics are different. If you become resistant to minocycline (a common agent used to treat acne), you don’t become resistant to antibiotics used to treat other diseases. The concern was that if you were to get sick and would need minocycline for a “real” disease, it would not be effective because the bacteria in your body wouldn’t be killed by minocycline. But minocycline isn’t used to treat other diseases! That’s partially why it is so commonly used in acne. You can take minocycline for a long time and not have to worry about brewing super-bugs in your body that can’t be killed by regular antibiotics.

Next, at Bellevue Acne Clinic we use antibiotics in as low dose as possible. For the first couple of months the dose of antibiotics is relatively high, to help kill the bacteria and “mow down the field,” so to speak. After a couple of months, the dose is dropped to a level that no longer kills bacteria, and therefore does not breed resistance.

If the dose is too low to kill bacteria, how does it help fight acne? Studies show that at low, sub-antimicrobial doses, antibiotics still have an anti-inflammatory effect. That means that these medications continue to have a therapeutic effect on your skin.

This argument is a bit oversimplified. There is some evidence that P. Acnes is an emerging strain of bacteria, which means it has been implicated in infections other than acne. There is also some risk that minocycline can cause your shins to turn blue (no kidding!). There is of course also a risk that not treating your acne will cause long-term serious effects too, like scarring. At Bellevue Acne Clinic, we help you weigh these risks along with the benefits and come up with a treatment plan that best meets your needs. That treatment plan may include oral antibiotics.

Antibiotics should be used at as low a dose as possible, for as short of a duration as possible. Whenever antibiotic therapy is initiated, you and your acne care provider should consider the length of treatment and a timeline for dose reduction.

Some people stay on antibiotics for years, and some never need them at all. Be sure to find an acne care provider that considers your needs and personalizes your treatment plan.

Bellevue Acne Clinic, where medicine meets total wellness.

 

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