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Efficacy of oral isotretinoin in the control of skin and nasal colonization by antibiotic-resistant propionibacteria in patients with acne.
Br J Dermatol 2005; 153(6):1126-36BJ

Abstract

BACKGROUND

Skin colonization by antibiotic-resistant propionibacteria is commonplace among acne patients globally. Increasing attention is now being paid to how resistance rates might be reduced to preserve the future efficacy of antibiotics, especially erythromycin and clindamycin in acne therapy.

OBJECTIVE

To assess the efficacy of oral isotretinoin in the control of antibiotic-resistant propionibacteria.

METHODS

Acne patients (72 in the U.K., 62 in the U.S.A.) colonized with high numbers of antibiotic-resistant propionibacteria were sampled before, during and 12 weeks after oral isotretinoin therapy. Propionibacterial samples were collected from five acne-prone skin surface sites using a detergent scrub method and from the anterior nares using moistened swabs. Total and antibiotic-resistant propionibacteria were enumerated by viable counting on media with and without selective antibiotics.

RESULTS

After 16 weeks of oral isotretinoin therapy, mean population densities of viable propionibacteria and variants resistant to erythromycin, clindamycin or tetracycline had fallen by more than 90% at all skin sites and in the nares. The sole exception was a smaller reduction in tetracycline-resistant strains on the lower back. In general, greater reductions were observed on skin than in the nares. By the end of the treatment period only three patients (all in Philadelphia) yielded no antibiotic-resistant strains from any site. Post-treatment, propionibacterial counts remained well below pretreatment levels but had begun to recover on the face and in the nares. The recovering propionibacterial population included both susceptible and resistant strains. Changes during and post-treatment at the two centres were similar but not identical.

CONCLUSIONS

Oral isotretinoin effectively reduced skin and nasal colonization by antibiotic-resistant propionibacteria. However, viable populations of resistant isolates persisted post-treatment at multiple sites. Novel methods are required to eradicate antibiotic-resistant propionibacteria completely, especially from the nasal reservoir.

Authors+Show Affiliations

School of Biochemistry and Microbiology, University of Leeds, Leeds LS2 9JT, U.K.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16307647

Citation

Coates, P, et al. "Efficacy of Oral Isotretinoin in the Control of Skin and Nasal Colonization By Antibiotic-resistant Propionibacteria in Patients With Acne." The British Journal of Dermatology, vol. 153, no. 6, 2005, pp. 1126-36.
Coates P, Vyakrnam S, Ravenscroft JC, et al. Efficacy of oral isotretinoin in the control of skin and nasal colonization by antibiotic-resistant propionibacteria in patients with acne. Br J Dermatol. 2005;153(6):1126-36.
Coates, P., Vyakrnam, S., Ravenscroft, J. C., Stables, G. I., Cunliffe, W. J., Leyden, J. J., ... Cove, J. H. (2005). Efficacy of oral isotretinoin in the control of skin and nasal colonization by antibiotic-resistant propionibacteria in patients with acne. The British Journal of Dermatology, 153(6), pp. 1126-36.
Coates P, et al. Efficacy of Oral Isotretinoin in the Control of Skin and Nasal Colonization By Antibiotic-resistant Propionibacteria in Patients With Acne. Br J Dermatol. 2005;153(6):1126-36. PubMed PMID: 16307647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of oral isotretinoin in the control of skin and nasal colonization by antibiotic-resistant propionibacteria in patients with acne. AU - Coates,P, AU - Vyakrnam,S, AU - Ravenscroft,J C, AU - Stables,G I, AU - Cunliffe,W J, AU - Leyden,J J, AU - Johnson,J, AU - Eady,E A, AU - Cove,J H, PY - 2005/11/26/pubmed PY - 2006/2/14/medline PY - 2005/11/26/entrez SP - 1126 EP - 36 JF - The British journal of dermatology JO - Br. J. Dermatol. VL - 153 IS - 6 N2 - BACKGROUND: Skin colonization by antibiotic-resistant propionibacteria is commonplace among acne patients globally. Increasing attention is now being paid to how resistance rates might be reduced to preserve the future efficacy of antibiotics, especially erythromycin and clindamycin in acne therapy. OBJECTIVE: To assess the efficacy of oral isotretinoin in the control of antibiotic-resistant propionibacteria. METHODS: Acne patients (72 in the U.K., 62 in the U.S.A.) colonized with high numbers of antibiotic-resistant propionibacteria were sampled before, during and 12 weeks after oral isotretinoin therapy. Propionibacterial samples were collected from five acne-prone skin surface sites using a detergent scrub method and from the anterior nares using moistened swabs. Total and antibiotic-resistant propionibacteria were enumerated by viable counting on media with and without selective antibiotics. RESULTS: After 16 weeks of oral isotretinoin therapy, mean population densities of viable propionibacteria and variants resistant to erythromycin, clindamycin or tetracycline had fallen by more than 90% at all skin sites and in the nares. The sole exception was a smaller reduction in tetracycline-resistant strains on the lower back. In general, greater reductions were observed on skin than in the nares. By the end of the treatment period only three patients (all in Philadelphia) yielded no antibiotic-resistant strains from any site. Post-treatment, propionibacterial counts remained well below pretreatment levels but had begun to recover on the face and in the nares. The recovering propionibacterial population included both susceptible and resistant strains. Changes during and post-treatment at the two centres were similar but not identical. CONCLUSIONS: Oral isotretinoin effectively reduced skin and nasal colonization by antibiotic-resistant propionibacteria. However, viable populations of resistant isolates persisted post-treatment at multiple sites. Novel methods are required to eradicate antibiotic-resistant propionibacteria completely, especially from the nasal reservoir. SN - 0007-0963 UR - https://www.unboundmedicine.com/medline/citation/16307647/Efficacy_of_oral_isotretinoin_in_the_control_of_skin_and_nasal_colonization_by_antibiotic_resistant_propionibacteria_in_patients_with_acne_ L2 - https://doi.org/10.1111/j.1365-2133.2005.06897.x DB - PRIME DP - Unbound Medicine ER -