2017年 6月 JAMA Dermatolに発表された、ニキビと薬剤耐性のClinical Review & Education。
What is the evidence for antibiotic resistance in acne, and how does resistance affect treatment?
Use of topical and systemic antibiotics for acne is associated with formation of resistance in Propionibacterium acnes and other bacteria, with clinical consequences. Guidelines recommend resistance reduction strategies including avoidance of antibiotic monotherapy, combination treatment with topical modalities, and limiting the duration of oral antibiotic use.
Use of antibiotics for acne is associated with development of resis- tance in P acnes, mostly via point mutations.
Multiple countries report resistance in greater than half of P acnes isolates, predominantly to topical erythromycin and clinda- mycin, and less so to tetracyclines.
The clinical efficacy of topical erythromycin decreased from the 1970s to 2002, attributed to antibiotic resistance.
Resistant P acnes is found on the skin of untreated contacts of acne patients prescribed antibiotics.
Resistant strains of P acnes are reported to cause severe infections; therefore, current prescrib- ing practices may represent a risk to untreated contacts, espe- cially those with impaired immunity.
After discontinuation of therapy, resistance may persist.
Although P acnes is not known to acquire resistance from or transfer it to other bacteria,1 using antibiotics for acne leads to off-target effects.
Use of topical antibiotics is associated with resistance in Staphylococcus aureus. This organism, especially when methicillin resistant, is responsible for potentially severe health care and community-associated infections. Treatment with oral tetracyclines is associated with lower S aureus carriage rates, without increased resistance.
In a retrospective cohort of more than 100 000 patients with acne, those treated with topical and/or oral antibiotics for at least 6 weeks were significantly more likely to develop upper respiratory infections during 1 year of follow-up than patients who had not received antibiotics (odds ratio, 2.15; 95% CI, 2.05- 2.23; P < .001).
In a prospective cohort of university students (N = 579), those receiving oral antibiotics for acne were more than 4 times more likely to report pharyngitis during 1 year of follow-up than untreated individuals (odds ratio, 4.34; 95% CI, 1.51-12.47).