Ways to limit antibiotic use

Avoid oral antibiotics as monotherapy in the treatment of acne.

“… for moderate/severe acne patients, oral antibiotics should not be used as monotherapy, but should be used in concert with topical retinoids and with antimicrobial products, such as benzoyl peroxide, that may limit the emergence of bacterial resistance,” according to Lawrence F. Eichenfield, M.D., president of AARS and professor of pediatrics and medicine (dermatology), University of California, San Diego School of Medicine.

Limit the use of oral antibiotics. If you need to use them, consider shortening duration of use, according to Diane Berson, M.D., associate clinical professor of dermatology, Weill Medical College of Cornell University New York-Presbyterian Hospital.

Avoid topical antibiotics as monotherapy in the treatment of acne, according to Dr. Berson, who also is a founding member of the American Acne and Rosacea Society. Consider using combinations that include a retinoid and benzoyl peroxide, such as Epiduo (adapalene and benzoyl peroxide gel 0.1%/2.5%, Galderma) instead of or in order to diminish topical antibiotic use, according to Dr. Berson. The consensus recommendation on topical antibiotics in the Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne, published in Pediatrics¹, puts it this way: “Topical antibiotics (clindamycin, erythromycin) are not recommended as monotherapy because of slow onset of action and predictable emergence of antibiotic-resistant bacterial organisms. (SOR: C). If topical antibiotic treatment is to be prolonged for more than a few weeks, topical [benzoyl peroxide] should be added, or used in combination products.”

1 Eichenfield LF, Krakowski AC, Piggott C, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013;131 Suppl 3(Supplement 3):S163-86.

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