MRSA and Oral Antibiotics for Acne

Question

How does the emergence of community-acquired MRSA affect the use of long-term antibiotics in the treatment of acne?

Response from Guy F. Webster, MD, PhD Clinical Professor, Jefferson Medical College, Department of Dermatology, Philadelphia, Pennsylvania

Methicillin-resistant Staphylococcus aureus (MRSA) is a growing problem in community practice, and it is reasonable to wonder whether the profligate use of antibiotics for acne and rosacea has played a role in its evolution. Given that MRSA is typically sensitive to tetracyclines, it seems safe to conclude that the use of these drugs in acne therapy did not spawn MRSA.

The corollary question is, "Should we modify our usage of antibiotics in the treatment of acne in light of their usefulness in the treatment of MRSA?" This is an important issue, because by excessive use of these drugs, we might educate MRSA to become resistant to tetracyclines and remove a useful drug from the armamentarium.

In 2009, antibiotics are still required to help many patients with moderate-to-severe acne, but we can certainly optimize and limit their use. Antibiotic-sparing agents include topical retinoids, benzoyl peroxide, topical dapsone, spironolactone, oral contraceptives, and isotretinoin. With judicious combination therapy, antibiotic use can be minimized and acne can be treated effectively.

This activity is supported by an independent educational grant from Medicis Pharmaceutical Corporation.