Trends in the treatment of acne vulgaris: are measures being taken to avoid antimicrobial resistance?

Background: Acne vulgaris has been treated with long-term courses of antibiotics since the 1960s. Antibiotic-resistance of Propionibacterium acnes (P. acnes) was first documented in the late 1970s, and, over 20 years later, the problem of antibiotic resistance still exists.

Purpose: The aim of this study was to assess trends in prescribing antibiotics for acne from 1997-2006.

Methods: The authors examined the National Ambulatory Medical Care Survey (NAMCS) database and recorded medications at all visits to the physician in which acne vulgaris (ICD-9-CM code 706.1) was the only diagnosis from 1997-2006.

Results: Declines in the use of erythromycin and isotretinoin (both P < 0.001) for acne were noted for all physicians. Tetracyclines saw significant increases in use by both dermatologists and non-dermatologists (P < 0.01 and P = 0.05, respectively). Prescribing of benzoyl peroxide monotherapy was unchanged for non-dermatologists (P = 0.22) and is on the decline for dermatologists (P < 0.001). The use of BPO + clindamycin combination topical treatments rose sharply for all physicians (P < 0.001), resulting in greater use of both total BPO and total clindamycin for acne over time (P < 0.001). Topical retinoid use increased among dermatologists (P < 0.05) but appeared to be on the decline among non-dermatologists (P = 0.067).

Conclusion: The development of antibiotic resistance is of concern. Greater awareness of retinoid use for maintenance therapy, using topical benzoyl peroxide to prevent resistance, and limiting use of oral antibiotics to as short a time period as possible are measures to contribute to better eco-responsible acne treatment.