Antibiotics have been a mainstay of acne treatment for decades. Antibiotics help kill acne bacteria (P. acnes) and also help reduce inflammation. However, it has also long been noted that they only work for about half of the population, and produce only moderate effectiveness. Next, they often only work for a short period of time. Acne tends to "get used to" antibiotic treatment and become resistant to it.
Stats: A large study conducted by the British Journal of Dermatology studied 4274 acne patients and found that since 1991 an average of 51% of patients harbored colonies of resistant bacteria. Other studies have shown similar levels of bacteria resistant acne bacteria. Interestingly, researchers are finding similar levels of resistance in both patients treated with antibiotics and those untreated as well, although those untreated have somewhat lower levels of resistance.
How it happens: On a microscopic level, geneticists and biologists are finding multiple possible reasons why this occurs. The first is gene mutation within a bacteria cell. Bacteria have also been observed banding together and producing biofilms, a coating which slows down penetration of antibacterial medication.
What to do about it: First, have a talk with your doctor if you are on long term antibiotic therapy. Next, if you are given antibiotics from a doctor, do not stop your course before speaking with her/him about it.
What stands out in the literature most boldly is the value of combining antibiotics with benzoyl peroxide or retinoids. When mixed with benzoyl peroxide, antibiotic therapy kills 99.9% of bacteria, resistant or not. Data is less available regarding the combination of retinoids such as Retin-A® or Adapalene® with antibiotic treatment. Lastly, isotretinoin (Accutane) has been shown to kill about 90% of these resistant bacteria, but still leave large colonies behind.
My 2 cents: I was on oral and/or topical antibiotics for a year or so altogether. Neither therapy did anything for me. Nothing. My skin was actually at its worst in my lifetime when I was on Clindamycin, a topical antibiotic. Antibiotics for me were like a bad joke-promising help but delivering nothing. Accutane finally cleared me up, although not entirely. When my acne returned after my the here at Acne.org finally got me cleared up for good.
References
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