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Acne Treatment: Combine treatments to reduce Resistance ?

Take Home Message: a third of patients have Propionibacterium resistance to conventional antibiotics (Study from India)

Comments:
Benzoyle Peroxide has an antibacterial action (also against Propionibacterium Acnes): resistance is not a problem here
-Antibiotics tested were: clindamycin, erythromycin, tetracycline, azithromycin, doxycycline and minocycline
-Propionibacterium studies here were not limited to Propionibacterium Acnes
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Abstract
Background: Globally Propionibacterium acnes is reported to have developed resistance to antibiotics, but there is paucity of such data from Indian subcontinent. Similarly there is very little data on the antibiotic sensitivity of other Propionibacterium spp which are incriminated in pathogenesis of acne.
Objectives: To determine antibiotic sensitivity of P. acnes and other Propionibacterium spp. isolated from patients with acne and to correlate it with previous antibiotic use.
Methods: Minimum inhibitory concentration of 124 strains of Propionibacterium spp (P. granulosum: 61, P. acnes: 56, P. propionicus: 5 and P. avidum: 2) isolated from patients with acne was determined against clindamycin, erythromycin, tetracycline, azithromycin, doxycycline and minocycline using Epsilometer test with resistant breakpoints being based on EUCAST guidelines.
Results: Overall 38 (30.7%) of 124 Propionibacterium spp isolates were resistant to at least one of the antibiotics tested, with 27 (21.8%) being resistant to more than one antibiotic. Thirty three (26.6%) of 124 strains of Propionibacterium spp were resistant to clindamycin, 21/75 (28%) to erythromycin and 9/49 (18.4%) to azithromycin. Resistance to antibiotics was more frequent with P. granulosum than with P. acnes, but the difference was statistically significant only for azithromycin. Resistance to clindamycin, the most frequently used topical antiacne antibiotic, correlated with its previous use.
Conclusion: About a third of Propionibacterium spp isolated from acne patients in India are resistant to at least one therapeutically used antibiotic. However, the study was conducted at a tertiary care centre and may not reflect the sensitivity pattern in the community.

Reference: Regional Congress of Dermatology (RCD) 2016 – Singapore. RCD16-0313 Acne & Rosacea ANTIBIOTIC SENSITIVITY OF PROPIONIBACTERIUM SPP ISOLATED FROM ACNE PATIENTS IN INDIA N. Khanna1, R. Chaudhary2, F. Hassan1, N. Sharma2, R. Khan3 1All India Institute of Medical Sciences, Dermatology, NEW DELHI, India 2All India Institute of Medical Sciences, Microbiology, New Delhi, India 3Rabigh Faculty of Science and Arts King Abdulaziz University, Department of Biological Science, P O Box 344 Rabigh 21911, Kingdom of Saudi Arabia