Is there an association between long-term antibiotics for acne and subsequent infection sequelae and antimicrobial resistance? A systematic review

Ketaki Bhate*, Liang Yu Lin, John S. Barbieri, Clemence Leyrat, Susan Hopkins, Richard Stabler, Laura Shallcross, Liam Smeeth, Nick Francis, Rohini Mathur, Sinead M. Langan, Sarah Jo Sinnott

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: Antimicrobial resistance (AMR) is a global health priority. Acne vulgaris is a common skin condition for which antibiotic use ranges from a few months to years of daily exposure.Aim: To systemically search for and synthesise evidence on the risk of treatment-resistant infections, and other evidence of AMR, following long-term oral antibiotic use for acne.Design & setting: In this systematic review, a literature search was carried out using the databases Embase, MEDLINE, Cochrane, and Web of Science. They were searched using MeSH, Emtree, or other relevant terms, and followed a pre-registered protocol.Method: Search strategies were developed with a librarian and undertaken in July 2019. All searches date from database inception. The primary outcome was antibiotic treatment failure or infection caused by a resistant organism. Secondary outcomes included detection of resistant organisms without an infection, rate of infection, or changes to flora.Results: A total of 6996 records were identified. Seventy-three full-text articles were shortlisted for full review, of which five were included. Two investigated rates of infection, and three resistance or changes to microbial flora. Three studies had 35 or fewer participants (range 20-118 496). Three studies had a serious or high risk of bias, one moderate, and one a low risk of bias. Weak evidence was found for an association between antibiotic use for acne and subsequent increased rates of upper respiratory tract infections and pharyngitis.Conclusion: There is a lack of high quality evidence on the relationship between oral antibiotics for acne treatment and subsequent AMR sequelae. This needs to be urgently addressed with rigorously conducted studies.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalBJGP Open
Issue number3
Publication statusPublished - Jun 2021

Bibliographical note

Funding Information:
John Barbieri receives partial salary support through a Pfizer Fellowship grant to the Trustees of the University of Pennsylvania.

Funding Information:
KB is funded by an NIHR Doctoral Research Fellowship DRF-2018–11-ST2-066. SL is funded by a Wellcome Trust Senior Clinical Fellowship (205039/Z/16/Z). JB is supported by the National Institute of Arthritis and Musculoskeletal and Skin Disease of the National Institutes of Health under award number T32-AR-007465. CL is funded by an MRC Skills Development Fellowship (MR/T032448/1). LS is funded by an NIHR Clinician Scientist Award (CS-2016-16-007). RM is funded by a Wellcome Trust Postdoctoral Fellowship (201375/Z/16/Z). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2021, The Authors.


  • acne vulgaris
  • antibiotic
  • antimicrobial resistance
  • dihydrofolate reductase inhibitor
  • macrolides
  • tetracycline


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