Pediatric dermatologist Dr. Luis Sáez-de-Ocariz calls for a reconsideration of antibiotic use as treatment for inflammatory acne. He calls for a more systematic, more effective approach to treatment. Speaking at a recent dermatology conference, he emphasized that patients who have undergone two or three courses of antibiotics should consider escalating their treatment to isotretinoin or spironolactone, especially for women. This recommendation is issued during increased scrutiny over the effectiveness and safety of antibiotics for acne treatment.
As highlighted by Dr. Sáez-de-Ocariz, who operates at Hospital Ángeles del Pedregal in Mexico City, taking the approach of individualized care is key to focusing on patients’ needs. He advocates that we do a better job at prescribing systemic antibiotics only when necessary. Length of therapy should be three to six months, based on clinical response. Most importantly, he emphasized the futility of using topical antibiotics in conjunction with systemic antibiotics.
Guidelines for Antibiotic Use in Acne Treatment
Dr. Sáez-de-Ocariz shed light on the situations in which oral antibiotics are justified. He identified four key situations: moderate to severe inflammatory acne, failure of topical treatments, extensive acne coverage, and the risk of scarring. He stated, “Antibiotics should only be prescribed for inflammatory lesions (papules, pustules, and nodules), not for comedones.”
In his speech, he similarly highlighted the value of better educating patients on the shortcomings of antibiotic treatment. “It’s necessary to tell the patient that the antibiotic treatment is only for the prescribed duration,” he remarked. He cautioned that patients may experience relapses after discontinuation and often attribute this to the cessation of antibiotics rather than an underlying issue.
Dr. Sáez-de-Ocariz underscored the need to do more than antibiotics alone. The strategy serves to combat the development of bacterial resistance, as is advised by every set of guidelines. He pointed out that the American Academy of Dermatology advises limiting the use of systemic antibiotics to three to four months. Perhaps most pointedly, he emphasized a need to adopt more holistic treatment approaches.
The Role of Nonantibiotic Therapies
Patricia Troielli dermatologist and TODAY SHOW adviser She is a scientific advisor to the Acne Committee of the Argentine Society of Dermatology and seconded Dr. Sáez-de-Ocariz’s wish. She emphasized the importance of focusing on nonantibiotic therapies first, whenever feasible. “Now is the time to reconsider our approach! Whenever possible, we should select nonantibiotic therapies for acne,” she stated.
As an example, Troielli enthusiastically cites the conclusions from a 2023 network meta-analysis. This study further confirms these findings, showing that oral isotretinoin is the only effective treatment for inflammatory lesions. Both experts agree that while antibiotics remain a valuable treatment option, supported by strong evidence for their effectiveness, they should be used judiciously.
Best Practices in Acne Management
During his presentation, Dr. Sáez-de-Ocariz addressed how to optimize acne treatment outcomes with best practice management strategies. He suggested placing topical antibiotics at the first-line treatment for mild to moderate inflammatory acne. If lesions improve but are not completely clear, he advises persisting with oral antibiotics in addition to the topical regimen for another 12 weeks.
He explained that for inflammatory lesions, using topical or oral antibiotics alone is just as effective as retinoids. By focusing on educating patients about the importance of sticking to a treatment regimen, dermatologists can reduce the potential dangers of antibiotics.
Dr. Sáez-de-Ocariz ended by reminding his fellow clinicians of the value of a good patient history. “If a patient has had inflammatory acne treated with antibiotics two or three times, even if it’s my first time seeing them, we should consider escalating treatment to isotretinoin or, for female patients, spironolactone or contraceptives,” he stated.
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