SYSTEMATIC REVIEW OF PROPIONIBACTERIUM-ACNES RESISTANCE TO SYSTEMIC ANTIBIOTICS

Objective: To document changes in the prevalence of resistance of Prop ionibacterium acnes to antibiotics used for treating acne. Data source s: MEDLINE and EMBASE were searched for publications on P. acnes resis tance to systemic antibiotics. The search strategy mapped ''acne'' or ''acne vulgaris'' with the terms ''antibiotic resistance'' or ''drug r esistance, microbial''. Only papers published in English during 1976 t o 1997 were included in the search. Study selection: 53 publications m et the search criteria. The search output was refined by selecting pap ers that specifically addressed P. acnes resistance patterns. Addition al studies (not included in the search output) were identified from re view articles and references of the retrieved articles. Twelve article s were reviewed. Data extraction: Data on the prevalence of antibiotic -resistant propionibacteria, the incidence of individual resistance ph enotypes, mixed resistance, and correlation between poor therapeutic r esponse and resistant propionibacteria were extracted. Data synthesis: Research since 1978 has suggested an association between poor therape utic response and antibiotic-resistant propionibacteria. The overall i ncidence of P. acnes antibiotic resistance has increased from 20% in 1 978 to 62% in 1996. Resistance to specific antibiotics varied and was most commonly reported with erythromycin and clindamycin, tetracycline and doxcycline, and trimethoprim. Resistance to minocycline is rare. Conclusions: In many patients with acne, continued treatment with anti biotics can be inappropriate or ineffective. It is important to recogn ise therapeutic failure and alter treatment accordingly. The use of lo ng-term rotational antibiotics is outdated and will only exacerbate an tibiotic resistance.