Susceptibility profiles of Propionibacterium acnes isolated from patients with acne vulgaris

The wide prescription of antibiotics in patients with acne vulgaris has generated the concern of emergence of antibiotic-resistant Propionibacterium acnes. To study the susceptibility profiles of P. acnes isolated from patients with acne vulgaris, 90 isolates were isolated from sebum collected from lesions of 191 patients. Susceptibilities to amoxicillin, minocycline, erythromycin and clindamycin were studied by the Etest method. Thirty-four isolates (37.8%) were resistant to both erythromycin and clindamycin, whereas another four isolates (4.4%) were resistant to all four tested antimicrobials. All resistant isolates to any of the tested antimicrobials had very high minimum inhibitory concentrations (>256 μg/mL). Among all analysed host factors, only history of oral treatment with macrolides and/or clindamycin within the last 2 years was independently associated with the acquisition of resistant P. acnes (odds ratio = 5.573; P = 0.001). The present results provide useful information to guide antimicrobial prescribing strategies in acne. Any information for past exposure to macrolides or clindamycin should suggest avoidance of prescription of these antibiotics. Tetracyclines and amoxicillin are the suggested solutions for these patients. In contrast, lack of history of exposure allows the safe prescription of macrolides and clindamycin.