CHU Nantes, Place Alexis Ricordeau, 44093 Cedex 01, France.
Eur J Dermatol. 2016 Apr 1;26(2):127-32. doi: 10.1684/ejd.2015.2685.
Acne is common in adolescence but is also increasingly seen in adulthood, with about 40% of adults being affected. Topical and systemic oral antibiotics have been used for more than 40 years in the treatment of acne lesions. In the 1970s, evidence of resistance to topical erythromycin and clindamycin was reported and, since then, antibiotic resistance in acne has been increasing worldwide. Antibiotic exposure can be significant in acne treatment because the patient population is large and there is a tendency for prolonged treatment regimens to be prescribed. The overuse of antibiotics is now considered a major public health problem. Action is therefore required to encourage judicial and appropriate use of antibiotics in acne management in line with available evidence-based guidelines. Alternatives to topical antibiotics for the treatment of acne should be considered. Topical antibiotics should no longer be used as monotherapy in acne treatment and use in combination regimens should be limited to a maximum of four weeks. Evidence from studies suggests that, as for topical antibiotics, oral antibiotics should not be used as monotherapy, but instead should be combined with a topical retinoid or benzoyl peroxide for a maximum of four months. Correct and appropriate use of antibiotics in the treatment of acne will help to preserve their utility in the face of increasing antibiotic resistance but greater awareness of the issues is required among prescribing physicians.
痤疮在青少年中很常见，但在成年中也越来越常见，约有 40%的成年人受到影响。局部和全身口服抗生素在痤疮皮损的治疗中已经使用了 40 多年。在 20 世纪 70 年代，就有报道称局部使用红霉素和克林霉素出现了耐药性，从那时起，痤疮中的抗生素耐药性在全球范围内不断增加。在痤疮治疗中，抗生素的使用可能非常重要，因为患者人群庞大，而且存在延长治疗方案的趋势。抗生素的过度使用现在被认为是一个主要的公共卫生问题。因此，需要采取行动，根据现有的循证指南，鼓励在痤疮管理中合理使用抗生素。应该考虑替代局部抗生素治疗痤疮的方法。局部抗生素不应再单独用于痤疮治疗，联合治疗方案的使用应限制在最多四周。研究证据表明，与局部抗生素一样，口服抗生素也不应单独使用，而应与局部维甲酸或过氧化苯甲酰联合使用，最长不超过四个月。在治疗痤疮时正确、适当地使用抗生素有助于在面对日益增加的抗生素耐药性时保持其效用，但需要提高处方医生对这些问题的认识。
