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Jo JH, Harkins CP, Schwardt NH, Portillo JA, Zimmerman MD, Carter CL, Hossen MA, Peer CJ, Polley EC, Dartois V, Figg WD, Moutsopoulos NM, Segre JA, Kong HH. Alterations of human skin microbiome and expansion of antimicrobial resistance after systemic antibiotics. Sci Transl Med 2021; 13:eabd8077. [PMID: 34936382 DOI: 10.1126/scitranslmed.abd8077] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jay-Hyun Jo
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Catriona P Harkins
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA.,Microbial Genomics Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nicole H Schwardt
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jessica A Portillo
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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- NIH Intramural Sequencing Center, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Matthew D Zimmerman
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Claire L Carter
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Md Amir Hossen
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Cody J Peer
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Eric C Polley
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD 20850, USA
| | - Véronique Dartois
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - William D Figg
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Niki M Moutsopoulos
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Julia A Segre
- Microbial Genomics Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Heidi H Kong
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA.,Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Karadag AS, Aslan Kayıran M, Wu CY, Chen W, Parish LC. Antibiotic resistance in acne: changes, consequences and concerns. J Eur Acad Dermatol Venereol 2020; 35:73-78. [PMID: 32474948 DOI: 10.1111/jdv.16686] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022]
Abstract
Antibiotic resistance in acne was first observed in the 1970s and has been a major concern in dermatology since the 1980s. The resistance rates and types of antimicrobials have subsequently shown great variations in regions and countries. Illustrative of this is the resistance to topical erythromycin and clindamycin which continues to be a problem worldwide, while resistance to systemic treatment with tetracyclines has remained low during the past decade. The resistance for the newer macrolides like azithromycin and clarithromycin has been increasing. The results of antibiotic resistance may include treatment failure of acne, disturbance of skin microbiota, induction of opportunistic pathogens locally and systemically, and dissemination of resistant strains to both healthcare personnel and the general population. The ensuing complications, such as aggravated opportunistic infections caused by Propionibacterium acnes and the emergence of multiresistant superbugs, have not yet been confirmed.
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Affiliation(s)
- A S Karadag
- Department of Dermatology and Venereology, School of Medicine, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - M Aslan Kayıran
- Department of Dermatology and Venereology, School of Medicine, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - C-Y Wu
- Department of Dermatology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - W Chen
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Department of Dermatology, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - L C Parish
- Department of Dermatology and Cutaneous Biology and Jefferson Center for International Dermatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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Ryan-Kewley AE, Williams DR, Hepburn N, Dixon RA. Non-antibiotic Isotretinoin Treatment Differentially Controls Propionibacterium acnes on Skin of Acne Patients. Front Microbiol 2017; 8:1381. [PMID: 28790988 PMCID: PMC5524737 DOI: 10.3389/fmicb.2017.01381] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 07/07/2017] [Indexed: 02/04/2023] Open
Abstract
Emergence and potential transfer of antibiotic resistance in skin microorganisms is of current concern in medicine especially in dermatology contexts where long term treatment with antibiotics is common. Remarkably, non-antibiotic therapy in the form of isotretinoin – a non-antimicrobial retinoid is effective at reducing or eradicating the anaerobe Propionibacterium acnes which is causally involved in the complex pathogenesis of Acne vulgaris. This study measured the extent of colonization of P. acnes in patients with primary cystic or severe acne from three defined skin sites in ‘non-lesion’ areas before, during and after treatment with isotretinoin. Patients attending acne clinics were investigated using standardized skin sampling techniques and the recovery of anaerobic P. acnes from 56 patients comprising 24 females and 32 males (mean age 22 years, age range 15–46 years) who were given a standard course of isotretinoin (1 mg/kg/day) are reported. P. acnes cultured from the external cheek surface of patients following treatment showed a significant reduction (1–2 orders of magnitude) compared with their pre-treatment status. Interestingly, other distinct sites (nares and toe web) failed to show this reduction. In addition, high levels of antibiotic-resistant P. acnes were recorded in each patients’ skin microbiota before, during and after treatment. In this study, microbial composition of the skin appears substantially altered by isotretinoin treatment, which clearly has differential antimicrobial effects on each anatomically distinct site. Our study confirmed that orally administered isotretinoin shows good efficacy in the resolution of moderate to severe acne that correlates with reductions in the number of P. acnes on the skin, including resistant isolates potentially acquired from previous treatments with antibiotics. Our study suggests that the role of tetracycline’s and macrolides, which are currently first line treatments in dermatology, might be reserved for severe or life-threatening infections since current antibiotic stewardship guidelines from medical departments no longer prescribe these antibiotics for routine use.
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Affiliation(s)
- Angela E Ryan-Kewley
- School of Health Sciences, Manchester Metropolitan UniversityManchester, United Kingdom.,Joseph Banks Laboratories, School of Life Sciences, University of LincolnLincoln, United Kingdom
| | - David R Williams
- Joseph Banks Laboratories, School of Life Sciences, University of LincolnLincoln, United Kingdom
| | - Neill Hepburn
- Dermatology Department, Lincoln County HospitalLincoln, United Kingdom
| | - Ronald A Dixon
- Joseph Banks Laboratories, School of Life Sciences, University of LincolnLincoln, United Kingdom
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Abdel Fattah NSA, Darwish YW. In vitro antibiotic susceptibility patterns of Propionibacterium acnes isolated from acne patients: an Egyptian university hospital-based study. J Eur Acad Dermatol Venereol 2012; 27:1546-51. [PMID: 23279041 DOI: 10.1111/jdv.12057] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Antibiotics have been used for more than 40 years against Propionibacterium acnes (P. acnes), the most common agent of acne. Antibiotic resistance to this bacterium becomes a worldwide problem in recent years. No studies are available on antibiotic susceptibility patterns of P. acnes among Egyptian acne patients. OBJECTIVE To determine antibiotic susceptibility patterns of P. acnes isolated from acne patients attending the Dermatology outpatient clinic of an Egyptian university hospital to the most commonly prescribed antibiotics and to determine the difference in relation to age of patients, disease duration and previous antibiotic therapy for acne. METHODS Cutaneous samples were obtained from pustular acne lesions on the face of 115 patients, which were cultured in anaerobic media to demonstrate the presence of P. acnes. Antibiotic susceptibility tests of isolated P. acnes were then performed to clindamycin, erythromycin, azithromycin, oxytetracycline and doxycycline by disk diffusion method. RESULTS Propionibacterium acnes was isolated from 98 patients. Eighty-nine isolates were susceptible to azithromycin, followed by doxycycline and oxytetracycline isolated from 82 and 72 patients respectively. Resistance of P. acnes to clindamycin was detected in 65 patients, followed by erythromycin in 48 patients. Comparing the antibiotic susceptibility patterns of P. acnes isolated from patients with and without previous antibiotic therapy for acne revealed statistically non-significant differences as regards any of the antibiotics tested except for clindamycin and erythromycin. Statistically non-significant differences existed between antibiotic susceptibility patterns of P. acnes to all tested antibiotics regarding age of patients (< or ≥ 20 years) and disease duration (< or ≥ 2 years). CONCLUSION Propionibacterium acnes in vitro susceptibility patterns differed among Egyptian patients to the commonly prescribed antibiotics with the highest to lowest resistance to clindamycin, erythromycin, oxytetracycline, doxycycline and azithromycin.
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Affiliation(s)
- N S A Abdel Fattah
- Departments of Dermatology & VenereologyClinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Moon SH, Roh HS, Kim YH, Kim JE, Ko JY, Ro YS. Antibiotic resistance of microbial strains isolated from Korean acne patients. J Dermatol 2012; 39:833-7. [PMID: 22779738 DOI: 10.1111/j.1346-8138.2012.01626.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Over several decades, topical and systemic antibiotics have been the mainstay of treatment for acne vulgaris. The widespread and long-term use of antibiotics in the treatment of acne has resulted in the spread of resistant bacterial strains and treatment failure. We aimed to examine the bacteriology of acne vulgaris and to evaluate its susceptibility to the antibiotics widely used for acne in Korea. We examined the species of bacteria aerobically and anaerobically isolated from 100 Korean acne patients. Among the bacteria isolated, Staphylococcus epidermidis (36 patients) was the most common, followed by Propionibacterium acnes (30 patients). Eleven strains of P. acnes (36.7%) and 25 strains of S. epidermidis (69.4%) were resistant to one or other of the antibiotics tested. A higher proportion of P. acnes isolates were resistant to clindamycin (30%) and erythromycin (26.7%), than to any other antibiotics tested (P = 0.0003). Some S. epidermidis isolates were resistant to tetracycline and doxycycline in addition to clindamycin and erythromycin. In the previous studies, few strains of P. acnes were found to be resistant to any of the antibiotics, but this study shows that antibiotic-resistant strains have been increasing in Korea acne patients.
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Affiliation(s)
- Sang Ho Moon
- Areumdaun Dermatologic Clinic Department of Dermatology, Hanyang University College of Medicine LeeJiHam Dermatologic Clinic, Seoul, Korea
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Toyne H, Webber C, Collignon P, Dwan K, Kljakovic M. Propionibacterium acnes (P. acnes) resistance and antibiotic use in patients attending Australian general practice. Australas J Dermatol 2012; 53:106-11. [PMID: 22571557 DOI: 10.1111/j.1440-0960.2011.00867.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Antibiotic resistance in the community, including transfer between bacteria, is a growing concern for clinicians. Acne is commonly treated in general practice, sometimes with antibiotics. The aim of this study is to measure the rate of carriage of antibiotic resistant Propionibacterium acnes 10 years apart in general practice and the relationship of resistance to type of treatment, as well potential effects on other flora. METHODS Patients (N = 215) with acne presenting to Australian Capital Territory and south-eastern New South Wales general practices were swabbed for P. acnes in 1997-1998 and 2007. Clinical details were collected with questionnaires. In 2007 swabs were also taken for Staphylococcus aureus and Streptococcus pneumoniae. GP's diagnostic classification of acne was tested using a set of standard photographs. RESULTS Resistant P. acnes was isolated from 20 patients (9%) and the proportion that was resistant was the same in 1997-1998 and in 2007. Antibiotic use, particularly topical, was associated with P. acnes resistance. Resistance rates declined with the time elapsed since ceasing antibiotics. Use of retinoids was associated with a decreased chance of growing P. acnes (P = 0.008) but not with decreased resistance. Simultaneous resistance with S. aureus was not detected, but only in 30 patients was S. aureus isolated. CONCLUSIONS P. acnes resistance was similar in 1997-1998 and in 2007.The chance of a patient carrying a resistant strain of P. acnes is significantly greater with recent exposure to antibiotics, and clinicians should limit prescribing where possible. Resistance disappears rapidly after ceasing antibiotics. Cross resistance with other organisms was not detected in this study.
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Affiliation(s)
- Helen Toyne
- Academic Unit of General Practice and Community Health, Australian Capital Territory Health Directorate and Australian National University Medical School, Canberra, Australian Capital Territory, Australia.
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Luk NMT, Hui M, Lee HCS, Fu LH, Liu ZH, Lam LY, Eastel M, Chan YKA, Tang LSN, Cheng TS, Siu FYC, Ng SC, Lai YKD, Ho KM. Antibiotic-resistant Propionibacterium acnes among acne patients in a regional skin centre in Hong Kong. J Eur Acad Dermatol Venereol 2011; 27:31-6. [PMID: 22103749 DOI: 10.1111/j.1468-3083.2011.04351.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There has been no study on antibiotic-resistant Propionibacterium acnes in Hong Kong. OBJECTIVE We investigated the prevalence and pattern of antibiotic-resistant P. acnes and to identify any associated factors for harbouring the resistant strains. METHODS Culture and sensitivity testing of P. acnes to commonly used antibiotics were performed. Resistance to tetracycline was defined at a minimal inhibitory concentration (MIC) of 2 μg/mL or more; erythromycin at an MIC of 0.5 μg/mL or more; clindamycin at an MIC of 0.25 μg/mL or more according to EUCAST. For breakpoints of doxycycline and minocycline, those with an MIC of 1 μg/mL or more were defined as resistant strains. RESULTS Among the 111 specimens collected from 111 patients, 86 strains of P. acnes were recovered, one from each specimen. Twenty-five specimens had no growth. Forty-seven (54.8%) strains were found to be resistant to one or more antibiotics. Forty-six (53.5%), 18 (20.9%), 14 (16.3%), 14(16.3%) and 14 (16.3%) strains were resistant to clindamycin (CL), erythromycin (EM), tetracycline (TET), doxycycline (DOX) and minocycline (MR) respectively. Ten strains (11.6%) had cross resistance between the MLS antibiotics (erythromycin or clindamycin), one strain (1.2%) had cross resistance among the cyclines and 14 strains (16.4%) had cross resistance between the MLS and cycline antibiotics. Binary logistic regression showed an association between MLS antibiotic resistance with an increased age whereas cycline resistance was associated with the duration of treatment. CONCLUSION Antibiotic-resistant P. acnes is prevalent in Hong Kong. Dermatologists should be more vigilant in prescribing antibiotics for acne patients.
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Affiliation(s)
- N-M T Luk
- Dermatology Research Centre Department of Microbiology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong.
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Photodynamic therapy for acne vulgaris: A critical review from basics to clinical practice. J Am Acad Dermatol 2010; 63:183-93; quiz 193-4. [DOI: 10.1016/j.jaad.2009.09.056] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 09/10/2009] [Accepted: 09/10/2009] [Indexed: 11/23/2022]
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Farmery M, Jones' C, Eady E, Cove J, Cunliffe W. In vitro activity of azelaic acid, benzoyl peroxide and zinc acetate against antibiotic-resistant propionibacteria from acne patients. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639409084531] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Voils SA, Evans ME, Lane MT, Schosser RH, Rapp RP. Use of Macrolides and Tetracyclines for Chronic Inflammatory Diseases. Ann Pharmacother 2005; 39:86-94. [PMID: 15562139 DOI: 10.1345/aph.1e282] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To review the efficacy of macrolides and tetracyclines in several chronic inflammatory conditions. DATA SOURCES: Searches of MEDLINE (1966–March 2004) and an extensive bibliography search were undertaken. Key terms included acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis. STUDY SELECTION AND DATA EXTRACTION: Data were obtained primarily from randomized placebo-controlled trials upon which key recommendations are based. DATA SYNTHESIS: Antibiotics are often prescribed for months or even years for treatment of chronic inflammatory conditions such as acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis. Randomized controlled trials have shown that azithromycin is useful in the management of cystic fibrosis and the tetracyclines are beneficial in the management of rheumatoid arthritis, acne, blepharitis, and periodontitis. Several large, randomized controlled trials have failed to show any benefit of macrolides in the secondary prevention of cardiovascular disease. No randomized placebo-controlled clinical trials have been performed to assess the efficacy of macrolides or tetracyclines in patients with rosacea. CONCLUSIONS: The use of tetracyclines and macrolides for rosacea is based primarily on anecdotal reports or open-label trials. Limited clinical trials support the use of tetracyclines or macrolides in acne, blepharitis, periodontitis, rheumatoid arthritis, and cystic fibrosis. Trials to date do not support the use of antibiotics for secondary prevention of cardiovascular disease.
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Higaki S, Nakamura M, Morohashi M, Hasegawa Y, Yamagishi T. Anti-lipase activity of Kampo formulations, coptidis rhizoma and its alkaloids against Propionibacterium acnes. J Dermatol 1996; 23:310-4. [PMID: 8675819 DOI: 10.1111/j.1346-8138.1996.tb04021.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Anti-lipase activity of Kampo formulations, Coptidis Rhizoma (CR), and its alkaloids against Propionibacterium acnes were examined in vitro. The amounts of propionic and butyric acids in the medium were measured as growth and lipase activity of P. acnes, respectively. In tributyrin-PYG medium with each concentration of Kampo formulation, CR, or the alkaloids added, the production of propionic acid was suppressed remarkably more than that of butyric acid. The suppression of production of these acids by CR was higher than that of the alkaloids. Furthermore, no lipase-negative colonies were found on the medium to which Kampo formulations were added. From these observations, we concluded that not only Kampo formulations and CR, but also their alkaloids, showed suppression of growth of P. acnes, which reduced anti-lipase activity. Furthermore, it was suggested that Kampo formulations and Kampo crude drugs with anti-lipase activity to P. acnes should be synergistic when their ingredients are combined.
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Affiliation(s)
- S Higaki
- Department of Dermatology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Japan
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Higaki S, Hasegawa Y, Morohashi M, Takayoshi Y. The correlation of Kampo formulations and their ingredients on anti-bacterial activities against Propionibacterium acnes. J Dermatol 1995; 22:4-9. [PMID: 7897023 DOI: 10.1111/j.1346-8138.1995.tb03332.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The correlation between the susceptibilities of Propionibacterium acnes strains to two Kampo formulations and these to their ingredients (Kampo crude drugs) was examined. Two out of 19 Kampo crude drugs, Coptidis Rhizoma (CR) and Phellodendri Cortex (PC), inhibited the growth of P. acnes significantly. The patterns of distribution of the minimal inhibitory concentrations of Keigai-rengyo-to (KRT) and of Seijo-bofu-to (SBT) were almost the same as those of the Kampo crude drugs, except CR and PC. Furthermore, no correlations between MICs of Kampo formulations and those of their ingredients against P. acnes were found. This might be due to mutual inhibition or to differences in anti-bacterial mechanisms between the two Kampo formulations and their ingredients. The Kampo formulations, composed of CR, PC and a few other kinds of Kampo crude drugs, might be more susceptible against P. acnes, since higher concentrations of the effective ingredients can be achieved.
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Affiliation(s)
- S Higaki
- Department of Dermatology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Japan
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Nishijima S, Akamatsu H, Akamatsu M, Kurokawa I, Asada Y. The antibiotic susceptibility of Propionibacterium acnes and Staphylococcus epidermidis isolated from acne. J Dermatol 1994; 21:166-71. [PMID: 8014270 DOI: 10.1111/j.1346-8138.1994.tb01715.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We studied the susceptibility of antimicrobial agents to Propionibacterium acnes (P. acnes) and Staphylococcus epidermidis (S. epidermidis) isolated from acne patients. We measured the minimum inhibitory concentrations (MICs) of the following five drugs: roxithromycin (RXM), erythromycin (EM), clindamycin (CLDM), minocycline (MINO) and ofloxacin (OFLX), which are frequently used to treat acne and skin infections. We found many resistant strains of S. epidermidis and some resistant strains of P. acnes. There was a correlation between the resistance of S. epidermidis and the former therapy for acne, but no distinct correlation between the resistance of P. acnes and the former therapy for acne.
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Affiliation(s)
- S Nishijima
- Department of Dermatology, Kansai Medical University, Osaka, Japan
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HOLLAND KT, BOJAR RA, CUNLIFFE WJ, CUTCLIFFE AG, EADY EA, FAROOQ L, FARRELL AM, GRIBBON EM, TAYLOR D. The effect of zinc and erythromycin on the growth of erythromycin-resistant and erythromycin-sensitive isolates of Propionibacterium acnes: an in-vitro study. Br J Dermatol 1992. [DOI: 10.1111/j.1365-2133.1992.tb15124.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Holland KT, Bojar RA, Cunliffe WJ, Cutcliffe AG, Eady EA, Farooq L, Farrell AM, Gribbon EM, Taylor D. The effect of zinc and erythromycin on the growth of erythromycin-resistant and erythromycin-sensitive isolates of Propionibacterium acnes: an in-vitro study. Br J Dermatol 1992; 126:505-9. [PMID: 1610692 DOI: 10.1111/j.1365-2133.1992.tb11826.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The effect of zinc and erythromycin on cultures inoculated with mixtures of different ratios of erythromycin sensitive (ES) and resistant (ER) Propionibacterium acnes cells was studied in vitro. Propionibacterium acnes ES outgrew P. acnes ER in the absence of erythromycin and zinc. At low levels of erythromycin ES outgrew ER, whilst the addition of 600 pg/ml zinc further reduced the growth of ER compared to ES. Growth of ER and ES were similar at levels of erythromycin near the minimum inhibitory concentration (MIC) of ES cells. Concentrations above the MIC for ES cells inhibited ES but not ER cells. At the higher concentrations of erythromycin, the addition of 96 ng/ml zinc delayed the growth of ER cells, whilst the addition of 300 micrograms/ml zinc prevented the growth of ER cells. The combination of erythromycin and zinc, at appropriate concentrations, inhibits both ES and ER.
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Affiliation(s)
- K T Holland
- Department of Microbiology, University of Leeds, U.K
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Eady EA, Cove JH, Holland KT, Cunliffe WJ. Erythromycin resistant propionibacteria in antibiotic treated acne patients: association with therapeutic failure. Br J Dermatol 1989; 121:51-7. [PMID: 2527056 DOI: 10.1111/j.1365-2133.1989.tb01399.x] [Citation(s) in RCA: 206] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Erythromycin resistant (EmR) propionibacteria were isolated from the skin surface of 51% of patients treated with oral erythromycin and 42% of patients treated with topical clindamycin compared with 3% of untreated control subjects (P less than 0.001). Amongst the topical clindamycin-treated patients, there was a higher incidence of EmR propionibacterial carriage in those patients who had previously been treated with oral erythromycin (64%) than in patients with no known previous exposure to erythromycin (20%; 0.01 greater than P greater than 0.001). Patients responding to oral erythromycin treatment carried EmR propionibacteria less frequently (24%) than patients who were not responding or who had relapsed (70%; P less than 0.001). These observations suggest that the use of oral erythromycin and/or topical clindamycin encourages the development of resistant propionibacteria and that the emergence of resistant strains is associated with therapeutic failure in erythromycin-treated patients. In total 63 resistant isolates were obtained from 52 subjects. There were 42 strains of Propionibacterium acnes, 16 strains of Propionibacterium granulosum and five strains of Propionibacterium avidum. The majority of isolates were inducibly or constitutively resistant to macrolide (e.g. erythromycin), lincosamide (e.g. clindamycin) and streptogramin B type antibiotics. Therefore, the isolates are phenotypically indistinguishable from the majority of EmR bacteria in which resistance is due to methylation of 23S ribosomal RNA.
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Affiliation(s)
- E A Eady
- Department of Microbiology, University of Leeds, U.K
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Kurokawa I, Nishijima S, Asada Y. The antibiotic susceptibility of Propionibacterium acnes: a 15-year bacteriological study and retrospective evaluation. J Dermatol 1988; 15:149-54. [PMID: 2971698 DOI: 10.1111/j.1346-8138.1988.tb03667.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Eady EA, Cove JH, Blake J, Holland KT, Cunliffe WJ. Recalcitrant acne vulgaris. Clinical, biochemical and microbiological investigation of patients not responding to antibiotic treatment. Br J Dermatol 1988; 118:415-23. [PMID: 2965598 DOI: 10.1111/j.1365-2133.1988.tb02437.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A small, but clinically significant proportion of acne patients fail to respond adequately to antibiotic therapy. All non-responding acne patients attending the Leeds General Infirmary between September 1985 and April 1986 (49 out of a total of 610 patients; 8%) were investigated with respect to changes in their acne grade, microbial flora and sebum excretion rate. They were compared with 22 age and sex matched untreated control subjects. It was found that in 65% of non-responding patients there was no microbiological abnormality, in 16% there was evidence of Gram-negative folliculitis and 20% carried predominantly antibiotic resistant propionibacteria compared with only 5% of untreated controls. There was a significant association between erythromycin therapy and the isolation of erythromycin resistant propionibacteria (P less than 0.001). A causal link, however, has yet to be established between carriage of antibiotic resistant propionibacteria and failure to respond to antibiotic therapy. Our results show that for most patients with recalcitrant acne a non-microbiological explanation must be sought for the lack of therapeutic success. The mean sebum excretion rate (SER) of the non-responding patients was significantly higher than that of matched untreated acne patients (P less than 0.001). A majority of non-responders (69%) had an SER above the upper 95% confidence limit of the control mean. The SER may affect treatment efficacy by influencing the antibiotic concentration within the pilosebaceous ducts.
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Affiliation(s)
- E A Eady
- Department of Microbiology, University of Leeds, U.K
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