Abstract
Background: Antimicrobial resistance (AMR) is a major global health priority and antibiotics are the leading contributor to increasing AMR. Acne is highly prevalent and antibiotics are widely used in its treatment. Average antibiotic use for acne ranges from a few months to many years. The dominant role antibiotics play in the treatment of healthy people with acne leads to questions about associations with AMR. Aim: To systemically search for and synthesize evidence around whether long-term oral antibiotic use in the treatment of acne in those over 8 years of age contributes to increased risk of infection or other outcomes suggestive of AMR. Method: We searched the following databases: Embase, MEDLINE, Cochrane and Web of Science using strategies developed with a librarian. Searches ran in July 2019 and date back to database inception. Inclusion criteria: RCT, cohort or case-control studies investigating oral antibiotics for minimum of 28 days compared to those with acne not treated with oral antibiotics or the general population. Primary outcome: antibiotic treatment failure or infection caused by a resistant organism. Data extraction and bias assessment using ROBINS-I were undertaken by three reviewers with medical and epidemiological training. Results: 6996 abstracts and titles were screened for eligibility, 73 full text papers were reviewed and seven studies were included comprising one RCT, five cohort studies and one case-control study. Due to heterogeneity it was not possible to perform meta-analysis. Four studies investigated changes to flora (total across studies n=141,20-60) and three susceptibility of infection (total across studies n=35,019,102-34,623) including pharyngitis and respiratory infections. Studies had mixed findings and most had a serious or critical bias risk. Conclusion: The relationship between long-term antibiotics for acne and infectious or resistance sequelae needs to be urgently addressed with more rigorous studies.
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