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Long-term use of antibiotics to treat acne can lead to antibiotic-resistant strains of bacteria in patients' mouths

Individuals with acne are generally healthy patients who are often treated with long-term antibiotics to control and prevent acne outbreaks. This treatment can lead to antibiotic-resistant strains of bacteria in the oropharynx of these patients, according to a study supported by the Agency for Healthcare Research and Quality (HS10399).

Acne patients in this study who were undergoing topical or oral antibiotic therapy had more than a three-fold increase in the prevalence of Streptococcus pyogenes in their oropharynx when compared with those who were not using any antibiotics. In fact, its prevalence in 33 percent of patients on antibiotics was as high as that documented in patients with symptomatic pharyngitis. Topical antibiotics, like oral antibiotics, may selectively eliminate certain bacteria. This may cause shifts in the microbial equilibrium that allow species such as potentially pathogenic S. pyogenes to flourish when they otherwise would be held in check, suggest the researchers.

They compared the prevalence and patterns of resistance to tetracycline antibiotics of S. pyogenes and Staphyloccocus aureus in the oropharynx of 42 people with acne using oral or topical antibiotics and 63 acne patients not using antibiotics. A total of 85 percent of S. pyogenes cultures from antibiotic users were resistant to at least one tetracycline antibiotic compared with 20 percent from those not using antibiotics. Of those not using antibiotics, 29 percent had positive S. aureus cultures compared with 22 percent of those using antibiotics. There were no significant differences in resistance patterns of S. aureus.

For more information, see "Effect of antibiotics on the oropharyngeal flora in patients with acne," by Ross M. Levy, B.A., Eric Y. Huang, M.D., Ph.D., Daniel Roling, M.D., and others in the April 2003 Archives of Dermatology 139, pp. 467-471.

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