Antibiotic resistance to Propionobacterium acnes: worldwide scenario, diagnosis and management

Abstract

Antibiotic resistance in cutaneous Propionobacterium is a global problem. As a general rule, resistance levels are high to macrolides, trimethoprim/sulfamethoxazole and clindamycin, while tetracyclines and levofloxacin have low resistance potential. Newer preparations like doxycycline MR and doxycycline 20 mg are subantimicrobial and may not lead to resistance. Sampling techniques are crucial to determine resistance. Genomic evaluation using 16S ribosomal RNA gene sequencing can be useful in diagnosing mutations and mapping phylotypes of Propionobacterium acnes. Resistance may lead to slow response and relapses. Apart from benzoyl peroxide, azelaic acid, topical dapsone, oral zinc and retinoids, novel molecules with little resistance potential include octadecenedioic acid, phytosphingosine, lauric acid, retapamulin, resveratrol, T-3912 and NB-003. The use of oral retinoids and non-antibiotics like zinc can prevent resistance and help reduce the dependence on antibiotics.

Keywords:

• 16S RNA PCR
• acne
• azelaic acid
• biofilms
• BPO
• clindamycin
• lauric acid
• levofloxacin
• macrolides
• NB-003
• resistance
• resveratrol
• retapamulin
• T-3912

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Antibiotic resistance varies from a high level in the USA, parts of Europe, UK, India and southeast Asia to low levels in South America, Japan and Australia.

• It is related both to the type and duration of antibiotic.

• MLS class of drugs should be avoided and tetracyclines remain the preferred antibiotic class at present.

• Novel antibiotics include modified release and subantimicrobial doses of doxycycline.

• Resistance is mutation based and permanent. T

• Resistant strains can to spread to other contacts.

• Numerous novel agents that have been compared with benzoyl peroxide include octadecenedioic acid, phytosphingosine, lauric acid, NB-003 and resveratrol.

• For now, minocycline, retinoids (oral/topical), systemic zinc, azelaic acid, topical dapsone and benzoyl peroxide and its combination remain the ideal agents to treat acne and prevent resistance.