Grada Ayman, Ghannoum Mahmoud A, Bunick Christopher G
Grada Dermatology Research, LLC, Chesterbrook, PA 19087, USA.
Center of Medical Mycology, Integrated Microbiome Core, Department of Dermatology, Case Western Reserve University, Cleveland, OH 44106, USA.
Antibiotics (Basel). 2022 May 27;11(6):722. doi: 10.3390/antibiotics11060722.
Tetracycline class antibiotics are widely used for multiple skin diseases, including acne vulgaris, acne rosacea, cutaneous infections, inflammatory dermatoses, and autoimmune blistering disorders. Concerns about antibiotic resistance and protecting the human/host microbiome beg the question whether broad-spectrum tetracyclines such as doxycycline and minocycline should be prescribed at such a high rate by dermatologists when a narrow-spectrum tetracycline derivative, sarecycline, exists. We evaluated the clinical effectiveness of oral sarecycline against cutaneous staphylococcal infections, eyelid stye, and mucous membrane pemphigoid to determine whether sarecycline is a viable option for clinicians to practice improved antibiotic stewardship. We observed significant improvement in staphylococcal infections and inflammatory dermatoses with courses of oral sarecycline as short as 9 days, with no reported adverse events. These clinical findings are consistent with in vitro microbiological data and anti-inflammatory properties of sarecycline. Our data provides a strong rationale for clinicians to use narrow-spectrum sarecycline rather than broad-spectrum tetracyclines as a first-line agent in treating staphylococcal skin infections and inflammatory skin diseases for which tetracyclines are currently commonly employed. Such advancement in the practice paradigm in dermatology will enhance antibiotic stewardship, reduce risk of antibiotic resistance, protect the human microbiome, and provide patients with precision medicine care.
四环素类抗生素广泛用于多种皮肤病，包括寻常痤疮、玫瑰痤疮、皮肤感染、炎症性皮肤病和自身免疫性大疱性疾病。由于对抗生素耐药性的担忧以及对人类/宿主微生物群的保护，人们提出了一个问题：当窄谱四环素衍生物沙瑞环素存在时，皮肤科医生是否应以如此高的比例开具多西环素和米诺环素等广谱四环素类药物。我们评估了口服沙瑞环素治疗皮肤葡萄球菌感染、睑腺炎和黏膜类天疱疮的临床疗效，以确定沙瑞环素是否是临床医生改善抗生素管理的可行选择。我们观察到，口服沙瑞环素疗程短至9天，葡萄球菌感染和炎症性皮肤病有显著改善，且无不良事件报告。这些临床发现与沙瑞环素的体外微生物学数据和抗炎特性一致。我们的数据为临床医生在治疗葡萄球菌皮肤感染和炎症性皮肤病时使用窄谱沙瑞环素而非广谱四环素作为一线药物提供了有力依据，目前四环素类药物常用于此类疾病的治疗。皮肤病治疗模式的这种进步将加强抗生素管理，降低抗生素耐药性风险，保护人类微生物群，并为患者提供精准医疗护理。
