Prolonged doxycycline for acne treatment- Implication of bacteria resistance

Oct 08, 12 Prolonged doxycycline for acne treatment- Implication of bacteria resistance

The standard recommended treatment for moderate acne is a course of antibiotics, commonly doxycycline. And clinicians often prescribe a whooping 3-6 months worth of the same antibiotics for the patients. We all heard that prolonged antibiotics makes our bacteria stronger which may mean that we will need to use an even stronger antibiotics in the future. Should we be concerned about this? And if so, why are we still advocating a prolonged course of antibiotics for the treatment of acne?

In this article, we will mainly discuss on the implication of using prolonged doxycycline, a commonly used antibiotics for the treatment of acne in patients.

What is doxycycline and how does it work on acne?

Doxycycline is a type of antibiotic that belongs to the tetracycline group. In acne, it targets the clogging of pores via reduction of proliferation of skin cells over the pores as well as acts upon the bacteria associated with acne, Propionibacterium acnes.

Does doxycycline cause bacteria resistance?

As in all other antibiotics, doxycycline can cause bacteria resistance when used frequently or with prolonged usage. Hence, prolonged consumption can induce Propionibacterium acnes resistance towards doxycycline. However, it does not cause Propionibacterium acnes resistance towards other antibiotics belonging to other groups. This may imply that there is a possibility that prolonged usage in a patient of acne may reduce the its’ efficacy used for future treatment of acne. Hence, the second course of doxycycline used for acne treatment may not work as well as the first course.

Of note, Propionibacterium acne does not only cause acne. It may also cause a variety of other diseases, such as eye infections, post-operative infections, device related infections, prosthetic heart valves infections and etc. Fortunately enough, the preferred antibiotic used for the treatment of such infections is not doxycycline or doxycycline related group. Instead, the preferred group of antibiotics use includes penicillin group, cephalosporin group as well as vancomycin. This implies that even if the patient developed infection with Propionibacterium acnes elsewhere, the bacteria resistance towards doxycycline will not affect the treatment.

In conclusion, doxycycline resistance in Propionibacterium acne may only affect the efficacy to treat acne in future acne treatment but will not affect the treatment of Propionibacterium acnes infecting elsewhere.

Will doxycycline resistance develop in other common organisms causing infections elsewhere?

Doxycycline resistance may develop in other organism elsewhere in our body, which may cause common infections such as sore throat and other respiratory tract infections. However, it is not commonly used to treat these common infection i.e. respiratory tract infection. Hence, even if the common organism causing sore throat is resistant to doxycycline, it will not affect the treatment outcome as the preferred treatment for such infection is normally not doxycycline.

So, shouldn’t we use doxycycline in all acne patients?

Doxycycline may or may not work in severe acne patients. In mild cases, the risk of side effects and resistance caused by doxycycline outweighs the benefit of starting doxycycline in them.

Doxycycline can be used in acne patients, provided that it is indicated and used safely. Bacteria resistance to doxycycline and various issues pertaining to it should be considered before starting a patient on the regiment.

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