Patients are often surprised that the antibiotics that we use
are really not used as antibiotics–acne is not an infection. You can’t pass on acne from one person to another. So yes, the antibiotics that we use may indeed suppress and
they do reduce the bacteria called P. Acnes. It doesn’t seem to be the main part of how they work.
The antibiotics that we use are also anti-inflammatories. They reduce the ability of white cells to get into the
skin. They reduce the inflammatory part of acne. It’s important to know that they work in two ways: The
anti-inflammatory and maybe some of it is anti-bacterial. They act slowly. The response to these is not as if you had a sore
throat from strep, and you take an antibiotic for a week, you kill off the bacteria and that’s it. In acne, they work
very slowly–you expect maybe a 50% improvement in the number of inflammatory spots that you have: less pimples
and pustules–maybe 50% over 12 weeks which is very slow. The philosophy, I think has changed from 20 years ago.
Individuals were put on antibiotics such as tetracycline for a very long time. We are now living in a world of antibiotic
resistance, and there is an awareness that maybe it’s not such a smart thing to use these antibiotics for a
very long time. There is a concern about antibiotic resistance not just to bacteria in the skin but bacteria in the gut
and transferring resistance to other organisms. I think the approach of many including myself, is to use
the oral antibiotics for as short a time as possible to try and reduce the amount of inflammation, get improvement
in the acne as quickly as you can. It help complicance–even if it responds quickly, it’s a long
time. We use antibiotics for 2 or 3 months, and then hope that topical medications that we have can keep the acne down
after the initial dose of oral antibiotics. That’s been an evolution in the way that we think about these
antibiotics. It does appear that if you add a topical benzoyl peroxide wash on to the skin when you’re on an oral
antibiotic, it may reduce the selection of resistant organisms. Whenever you use an antibiotic or any drug for a long time,
you always have to balance the advantages to the side-effects. Various antibiotics have different types of side-effects,
different things that we have to consdier when prescribing them, and it’s our responsibility to keep the patient safe. Antibiotics are useful, yes. If there were better
treatments, we’d use them.