Antibiotics in acne: time for a rethink

Over 10 years have passed since Anne Eady and her colleagues in Leeds demonstrated that therapeutic failure in acne may be related to bacterial resistance to antibiotics.1 The reluctance of clinicians to act on this information and to recognise the practices most likely to further this problem has led to a global increase in antibiotic resistance in P. acnes. In this issue, the Leeds group clearly show that P. acnes strains resistant to erythromycin, tetracycline, clindamycin and a variety of related antibiotics are to be found in Europe, USA, Australia and Japan.2 Through polymerase chain reaction, they demonstrate that the point mutations previously observed in the ribosomal RNA of resistant strains in the UK now occur across four continents and that the phenotypic pattern of resistance determined by MIC levels corresponds to the genomic pattern of mutation. For the first time the group have identified P. acnes with raised MIC levels to minocycline, although only in bacteria isolated from acne patients treated in the U.S.A.