Abstract
Acne is a common skin affliction that involves excess sebum production and modified lipid composition, duct blockage, colonization by bacteria, and inflammation. Acne drugs target one or more of these steps, with antibiotics commonly used to treat the microbial infection for moderate to severe cases. Whilst a number of other acne therapies are purported to possess antimicrobial activity, this has been poorly documented in many cases. We conducted a comparative analysis of the activity of common topical acne drugs against the principal etiological agent associated with acne: the aerotolerant anaerobic Gram-positive organism Propionibacterium acnes (recently renamed as Cutibacterium acnes). We also assessed their impact on other bacteria that could also be affected by topical treatments, including both antibiotic-sensitive and antibiotic-resistant strains, using broth microdilution assay conditions. Drugs designated specifically as antibiotics had the greatest potency, but lost activity against resistant strains. The non-antibiotic acne agents did possess widespread antimicrobial activity, including against resistant strains, but at substantially higher concentrations. Hence, the antimicrobial activity of non-antibiotic acne agents may provide protection against a background of increased drug-resistant bacteria.
Highlights
Antibiotics prescribed for acne can be topical or systemic
We report such a study against standardized accessible organisms from reference collections, testing both specific antibiotics used to treat acne and other acne agents reported to have antimicrobial activity
In addition to some of the most common strains identified by microbiome studies, we include several additional pathogenic bacteria that can be found on the skin and/or involved in skin infections, such as Streptococci (S. pyogenes and, less commonly S. pneumoniae23), Bacilli (B. subtilis, B. cereus and B. megaterium), Enterococci (E. faecium and E. faecalis), Micrococci (M. luteus and Kocuria rosea) and the Gram-negative bacteria Escherichia coli and Acinetobacter johnsonii[24]
Summary
There has not been a comparative assessment of the antimicrobial activity of commonly used antibiotics and topical acne agents against a set of representative commensal skin bacteria, including those not directly associated with acne We report such a study against standardized accessible organisms from reference collections, testing both specific antibiotics used to treat acne (tetracycline, erythromycin, clindamycin, oxacillin, dapsone, along with control antibiotics vancomycin/colistin) and other acne agents reported to have antimicrobial activity (salicyclic acid, azelaic acid, benzoyl peroxide) (see Fig. 1). These are assessed against both sensitive and resistant bacterial strains, under anaerobic and aerobic conditions. In addition to some of the most common strains identified by microbiome studies, we include several additional pathogenic bacteria that can be found on the skin and/or involved in skin infections, such as Streptococci (S. pyogenes and, less commonly S. pneumoniae23), Bacilli (B. subtilis, B. cereus and B. megaterium), Enterococci (E. faecium and E. faecalis), Micrococci (M. luteus and Kocuria rosea) and the Gram-negative bacteria Escherichia coli and Acinetobacter johnsonii[24]
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