Resistance to antibiotics used in dermatological practice

The increased prevalence of bacterial resistance is one of the major proble ms of medicine today. Antibiotic resistance can be defined as the situation where the minimal inhibitory concentration is greater than the concentrati on obtainable in vivo. Resistance genes are easily transferred among bacter ia, especially bacteria on skin and mucous membranes. In dermatological pat ients the most important resistance problems are found among staphylococci, Propionibacterium acnes and, to some extent, streptococci. Staphylococcus aureus strains have developed worldwide resistance to penicillin due to bet alactamase production in >90% of cases, and methicillin resistance is now a major problem with resistance levels of >50% in certain areas of the world . These resistant strains are often multiresistant, and include resistance to erythromycin and tetracycline, with resistance to quinolone developing r apidly. Group A streptococci are still susceptible to penicillin, but incre asing problems with erythromycin and tetracycline have been reported. After treatment with both systemic and oral antibiotics, P. acnes develops resis tance in more than 50% of cases, and it is estimated that one in four acne patients harbours strains resistant to tetracycline, erythromycin, and clin damycin. To limit the development of antibiotic resistance, it is necessary to establish an antibiotic policy (prescription rules. reimbursement strat egy, development of both national and local guidelines, and limitations on non-medical use). Clinicians also need access to rapid diagnostic methods, including resistance testing. This may provide further data for surveillanc e systems, reporting both antibiotic consumption and resistance levels. The involvement of clinical doctors in teaching and research in this area is p robably the most important aspect, along with their involvement in the form ulation of national and local guidelines. In the future we may consider it more important to ensure that future patients can be offered antibiotic tre atment, rather than focusing on the patient presenting today.