Antibiotic resistance – a call to challenge old habits

In June last year, the G8 Science Ministers met in London in order to address one of the most pressing health concerns facing the world today: antimicrobial resistance. We are all aware of this “major health security challenge of 21st century” and we understand how it has happened, but are we really doing enough to change our behavior?

In a context where bacteria continue to mutate and develop resistance to existing antibiotics, and with few antibiotic drugs in development to deal with these resistant bacteria, there is major concern that the world may someday have to deal with a “super bug”, which will make us victims of diseases we have been able to treat for decades.

The G8 ministers outlined many strategies to preserve the efficacy of existing antibiotics, one of the most important being to avoid their misuse and optimize their prescribing patterns. Traditionally, the ’culprit’ in antibiotic misuse has been their prescription for the common cold in children. However, if you look at the total use of antibiotics in the US, for example, many are prescribed for dermatological conditions, including acne .

The Global Alliance to Improve Outcomes in Acne, a leading expert group in acne,¹ and several dermatological societies such as the American Academy of Dermatology and some experts ^2,3 recommend that oral and topical antibiotics should not be used alone. The experts also recommend that concurrent use of oral and topical antibiotics should be avoided. Yet prescribing data indicates that 23 percent of oral antibiotic prescriptions are combined with a topical antibiotic⁴.

Indeed, this may be one of the reasons for the gradually increasing rates of antimicrobial resistant P. acnes strains. One study in Europe reports the chilling fact that up to 63 percent of P. acnes developed resistance to both topical erythromycin and clindamycin⁵.

There are currently few existing treatment alternatives to oral antibiotics. However, there are highly effective alternatives to topical antibiotics, including the use of a combined topical retinoid and benzoyl peroxide. So why do we not change our prescription habits, even when we can do so without impacting clinical outcomes? Challenging the continued use of topical antibiotics as first line therapy for acne is relevant and aligned with the goals of the recent G8 summit. In acne treatment this means responsibly prescribing oral antibiotics and avoiding the use of any topical antibiotics.

By changing our behavior in this way, patients will receive optimal treatment and we will succeed in preserving our valuable antibiotic resources for the future.

_

¹ Thiboutot D, Gollnick H, Bettoli V, Dreno B, Kang S, Leyden JJ et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. Journal of the American Academy of Dermatology 2009;60:S1-50
² Rosen T. Antibiotic resistance: an editorial review with recommendations. Journal of drugs in dermatology : JDD 2011;10:724-33
³ Dreno et al. European recommendations on the use of oral antibiotics for acne. Eur J Dermatol 2004; 14: 391-9
⁴ Market Insights IMS D+J Market – MAT Q4 2012 – WW (39 Countries)
⁵ Ross J, Snelling A et al. Antibiotic-resistant acne: lessons from Europe. Br J Dermatol 2003; 148:467– 478.