The American Academy of Dermatology has urged physicians to be mindful choosing antibiotics because of the growing threat of antimicrobial resistant, so, in addition to efficacy, physicians need to consider the negative implications for bacterial resistance and potential effects of medications on human microbiota when making treatment choices, say the authors of a review published in Future Microbiology.1
Oral antibiotics are widely used to treat patients experiencing inflammatory lesions in moderate-to-severe acne vulgaris, and the broad-spectrum tetracycline antibiotics doxycycline and minocycline are popular choices. However, they are associated with side effects including diarrhea and vaginal candidiasis, as well as increased bacterial resistance. There are growing concerns about the overuse of antibiotics in the tetracycline family due to a surge in tetracycline-resistant organisms.
Another tetracycline, sarecycline, was approved last year by the FDA for moderate-to-severe acne vulgaris in patients aged 9 years of age and older. Sarecycline possesses anti-inflammatory properties and potent activity against Gram-positive bacteria, including activity against multiple strains of Cutibacterium acnes, while exhibiting minimal activity against enteric aerobic Gram-negative bacteria.
While sarecycline demonstrated comparable efficacy to doxycycline and tetracycline against C. acnes, macrolide resistant organisms, methicillin-susceptible and resistant isolates as well as Staphylococcus epidermidis, it had four- to eight-fold less activity against bacteria that are part of the normal human microbiota.2
It is believed that disruption of gastrointestinal tract microbiota associated with use of doxycycline and minocycline may contribute to the increased incidence of gastrointestinal side effects, diarrhea, intestinal and vaginal fungal overgrowth and vaginal candidiasis, particularly in patients receiving prolonged oral therapy. Multidrug-resistant Gram-negative infections are increasingly prevalent and a source of major morbidity and mortality.
1. Moore AY, Charles JEM, Moore S. Sarecycline: a narrow spectrum tetracycline for the treatment of moderate-to-severe acne vulgaris. Future Microbiol. 2019 Sep 2. doi: 10.2217/fmb-2019-0199. [Epub ahead of print]
2. Zhanel G, Critchley I, Lin L-Y, Alvandi N. Microbiological profile of sarecycline, a novel targeted spectrum tetracycline for the treatment of acne vulgaris. Antimicrob. Agents Chemother. 63(1), e01297–e01218 (2019).
3. Conchie J, Munroe J, Anderson D. The incidence of staining of permanent teeth by the tetracyclines. Can. Med. Assoc. J. 103(4), 351(1970).
4. Moore A, Green LJ, Bruce S et al. Once-daily oral sarecycline 1.5 mg/kg/day is effective for moderate to severe acne vulgaris: results from two identically designed, Phase III, randomized, double-blind clinical trials. J. Drugs Dermatol.17(9), 987–996 (2018).