Duration of Oral Antibiotic Therapy for the Treatment of Adult Acne
29/03/2015 16:41
Evidence has mounted over the years that a combination of topical or systemic antibiotics and topical products is the most effective way of treating acne vulgaris. The antibiotics suppress the bacterial inflammation associated with the papules, pustules, nodules, and cysts. Of course, these lesions all develop from microcomedones, and comedolytic agents enhance the antibiotic effects, decreasing potential recurrence of the acne lesions. Topical retinoids have superior comedolytic effects, and, without a specific contraindication (eg, susceptibility to irritant effects associated with the drugs), we believe that most patients with acne should be using a retinoid.
One study after another has demonstrated that only about half of patients with acne who are treated by dermatologists and fewer than 10% treated by primary care physicians are using a topical retinoid as part of their regimen. It takes some time to properly educate acne patients about the risks and benefits of topical retinoids and about their proper use. Use of cream-based formulations, lower concentrations of retinoid, every-other-day regimens or twice weekly regimens, moisturizing topical antibiotics such as clindamycin lotion in the morning, or use of non-comedogenic moisturizing lotions in the morning allow us to treat the vast majority of our acne patients with a topical retinoid in a way that is well-tolerated by most patients.
Per this paper,1 we believe that better attention to the use of retinoids directed at the pathophysiology of acne will permit more patients to be managed with fewer months of oral antibiotics (3–6 months maximum based on guidelines) with cost savings and potentially lower risk of drug-resistant bacteria.
