Como evitar restistencia antibiótica en Acne...

Guidelines: Antibiotic Resistance in Acne Treatment

JAMA Dermatol; ePub 2017 Jun 21; Adler, et al

June 28, 2017

The American Academy of Dermatology's most recent guidelines for acne treatment recommend co-administration of benzoyl peroxide (BP), a topical bactericidal agent not reported to cause resistance, alongside both topical and oral antibiotics. BP is comedolytic and kills Propionibacterium acnes by generating free radicals. These guidelines recommend resistance reduction strategies, including avoidance of antibiotic monotherapy, combination treatment with topical modalities, and limiting the duration of oral antibiotic use. Highlights are as follows:

• For mild-to-moderate acne, first-line treatment is with BP, topical retinoids, or combination therapy, which may incorporate a topical antibiotic (BP + antibiotic, BP + retinoid, BP + antibiotic + retinoid). Topical antibiotic monotherapy is not recommended. In patients who benefit from topical antibiotic treatment, available fixed-combination antibiotic/BP formulations simplify the regimen and potentially improve patient adherence.
• For moderate-to-severe acne, first-line treatment is with oral antibiotics combined with BP and a topical retinoid. Oral antibiotic monotherapy is not recommended. Topical antibiotics may also be included in the regimen, provided BP is used concomitantly.
• The first-line oral antibiotics are doxycycline and minocycline, which exert anti-inflammatory as well as antimicrobial effects.
• Because of associated resistance, systemic erythromycin should be avoided, except in patients unable to tolerate tetracycline therapy (eg, pregnant women and children aged <8 years); trimethoprim-sulfamethoxazole may also be considered.
• Duration of therapy should preferably be limited to 3 to 4 months. To facilitate this, BP and topical retinoids should be continued as maintenance therapy after discontinuation of systemic antibiotic treatment.

Citation:

Adler BL, Kornmehl H, Armstrong. Antibiotic resistance in acne treatment. [Published online ahead of print June 21, 2017]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.1297.