Appropriate use guidelines
“It is important that physicians use antibiotics when they need to and I think that there are some appropriate recommendations in place for dermatologists to make sure that they are using antibiotics in the most judicious way possible. While I am highly concerned about antibiotic resistance, I do not tell people not to use antibiotics, but to be thinking about whether they really need to use them,” Dr. Eichenfield says.
Clinicians should use regimens of care that do not rely on antibiotics alone for the treatment of most dermatologic conditions, Dr. Eichenfield says, and when prescribing antibiotics, they should use the antibiotics for the shortest duration possible.
Drug effectiveness decline
According to Dr. Eichenfield, the dermatologic literature shows that some antibiotic agents that were highly effective in the past for some dermatologic conditions aren’t as effective anymore due to the growing bacterial resistances seen.
“In the past, we used to be able to effectively treat impetigo associated with streptococcus and staphylococcus with erythromycin but this is increasingly not the case anymore,” he notes. “Similarly, erythromycin resistant strains such as P. acnes have become very common, so much so that we do not even include that drug in our standard therapies anymore,” Dr. Eichenfield says.
Both acne and rosacea are included in a growing list of conditions and diseases that are being increasingly associated with inflammation and, as such, physicians are slowly shifting their focus toward the anti-inflammatory potential of the therapeutic regimens that they prescribe.
A significant amount of the positive effects of antibiotics may be due to their anti-inflammatory properties, Dr. Eichenfield says, and not just their antimicrobial qualities. Moreover, there is some evidence that using sub-antimicrobial levels — especially with rosacea — may allow appropriate good anti-inflammatory care with minimal impact on the development of antibiotic resistance.
“Using antibiotics only when necessary and especially pairing them with other medicines and topical regimens of care that can help maintain the benefits that you get when using oral antibiotics is one way to help contain the growing issue of antibiotic resistance,” Dr. Eichenfield says. “The strategy of using combination therapy and then switching over to topicals only can markedly decrease the exposure times and duration of antibiotics.”