Popular acne treatment may knock essential drug off shelf

PUNE: Here’s why your sore throat may not be getting cured with azithromycin.
In a country where the strongest antibiotics are falling like ninepins to resistant infections, a popular treatment for common acne is threatening to sink into oblivion an entire antibiotic class.
Dermatologists of Maulana Azad Medical College in Delhi trailing antibiotic-resistance patterns in acne cases are stumped by their new finding – almost all the cases they tested were resistant to azithromycin, commonly used to treat upper respiratory tract infections and pneumonia, among other conditions.
The research – genomic mapping of P.acnes and antibiotic resistance – is currently underway, but those at the helm have already sounded the alert – dermatologists should steer clear of azithromycin. They point out it is an off-label (not to be used) drug for acne treatment in any case.
Doctors said their fraternity has used a cannon to kill a fly –a higher antibiotic like azithromycin to treat acne. “Acne is a trivial problem and we have created resistance out of nothing. If general practitioners and paediatricians continue giving it, we stand to lose one whole antibiotic class,” said Dr Kabir Sardana, professor of dermatology at MAMC. who is spearheading the clinical research.
The resistance has drawn multiple worry lines. Dr Yashwant Tawade, head of department of dermatology at KEM hospital, Pune, said dermatologists in India had switched to doxycycline and azithromycin to treat acne after other antibiotics like tetracycline and erythromycin stopped working on the infection.
“Azithromycin is a good antibiotic, mainly used to treat upper respiratory tract infections, and could go out of circulation if resistance continues to build up,” he added.
Adding to the resistance is the almost-normal practice among adolescents and teenagers of sharing prescriptions and buying drugs over the counter to treat acne, and stopping the dosage midway as soon as the skin gets better.
The other concern is that of the population size that stands the risk of being resistant to the drug –an entire generation being raised on a heavy dose of azithromycin.
Paediatricians prescribe it widely to treat cough and cold and general practitioners and dermatologists to treat adolescents for similar infections and acne.
The most critical concern, however, is the use of this broad-spectrum drug leading to the acne-causing bacteria and also other microorganisms becoming resistant to other drugs as well. “There is no new medical discovery. We don’t have those many drugs,” said Dr Rajesh S Gokhale, director of Delhi-based Institute of Genomics and Integrated Biology, pointing out how the growing resistance to most drugs is an “under-appreciated problem”.
Besides, unregulated use has only increased the fitness of organisms, and reduced immunity of people, says Dr Gokhale. He explains that as resistance against antibiotics builds, the strains that are resistant to the drug can cause other infections, more commonly in the lungs.

Chest medicine specialists have already changed gears. “We have practically stopped prescribing azithromycin because of the resistance. We, however, still prescribe it for asthma and bronchitis, which is a three-month course,” said Dr Mahavir Modi, pulmonologist at Ruby Hall Clinic in Pune.
Dermatologists say they have already changed treatment protocols. “Antibacterials should not be used in mono therapy and for a short duration. Antibacterials should be avoided at least for localized acne,” says Dr Uday Khopkar, dermatologist with KEM, Mumbai. Dr Nina Madnani, consultant dermatologist with Hinduja Hospital, Mumbai said the topical antibiotics are now being combined with benzoyl peroxide and the resistant cases were becoming a concern.
Researchers say the resistance will only spread. “The organism causing acne can spread from one person to another if people don’t stop using antibiotics and which would ensure most people will stop reacting to antibiotics,” Dr Sardana said.