News & Perspective > American Journal of Clinical Dermatology

Oral Antibacterial Therapy for Acne Vulgaris

An Evidence-Based Review

Amanda Bienenfeld; Arielle R. Nagler; Seth J. Orlow

DISCLOSURES 

Am J Clin Dermatol. 2017;18(4):469-490

 

Abstract

Background To some degree, acne vulgaris affects nearly every individual worldwide. Oral antibiotic therapy is routinely prescribed for the treatment of moderate to severe inflammatory acne; however, long-term use of oral antibiotics for acne may have unintended consequences.

Objective The aim of this study was to provide a systematic evaluation of the scientific evidence on the efficacy and appropriate use of oral antibiotics in the treatment of acne.

Methods A systematic search of MEDLINE was conducted to identify randomized controlled clinical trials, systematic reviews, and meta-analyses evaluating the efficacy of oral antibiotics for acne. Overall, 41 articles that examined oral antibiotics compared with placebo, another oral therapy, topical therapy, alternate dose, or duration were included in this study.

Results Tetracyclines, macrolides, and trimethoprim/sulfamethoxazole are effective and safe in the treatment of moderate to severe inflammatory acne. Superior efficacy of one type or class of antibiotic could not be determined, therefore the choice of antibiotic is generally based on the side-effect profile. Although different dosing regimens have been studied, there is a lack of standardized comparator trials to determine optimal dosing and duration of each oral antibiotic used in acne. The combination of oral antibiotics with a topical therapy is superior to oral antibiotics alone.

Conclusion This article provides a systematic evaluation of the scientific evidence of the efficacy of oral antibiotics for acne. Due to heterogeneity in the design of the trials, there is insufficient evidence to support one type, dose, or duration of oral antibiotic over another in terms of efficacy; however, due to increasing resistance to antibiotics, dermatologists should heed consensus guidelines for their appropriate use.

Can Adolescent Obesity Increase Risk for Midlife Stroke?

Authors: Sue Hughes; CME Author:Laurie Barclay, MD;

CME Released: 7/28/2017

 MEDSCAPE CLINICAL BRIEFING

For unknown reasons, stroke incidence has been increasing among young adults, in tandem with the obesity epidemic. High body mass index (BMI) in young adulthood, but not in prepubertal childhood, is a risk factor for stroke in men. However, previous studies have been limited by the availability of only 1 BMI measurement, precluding separation of the effects on stroke risk of BMI at childhood and of BMI increase through puberty and adolescence.

The goal of the population-based BMI Epidemiology Study (BEST) in Gothenburg, Sweden, was to evaluate the contribution of prepubertal childhood BMI and BMI change through puberty and adolescence to risk for adult stroke in men.

• BMI increase through puberty and adolescence is a risk marker of adult stroke, based on findings from the BEST population-based study in Gothenberg, Sweden.
• Higher BMI increases during puberty may contribute to greater risk for adult stroke at least partly via increased blood pressure.
• Implications for the Healthcare Team: Avoiding excessive BMI increase during puberty may lower the risk for adult stroke; clinicians should consider monitoring adult blood pressure in men who had excessive BMI increase during puberty.
• An accompanying editorial highlights the exponential increase in obesity in adolescents, which may predict serious health consequences later in life.
• Because overweight children who normalized their BMI by age 20 years had no long-term increased risk for stroke, it is crucial that interventions target children and adolescents to prevent overweight and obesity in early adulthood.

Are all Penicillin Allergies in Children Real ?

Authors:Nicola M. Parry, DVM; CME Author: Charles P. Vega, MD
Medscape Clinical briefs 8/4/2017

Allergy to penicillin is 1 of the most common drug allergies encountered by clinicians, and the presence of penicillin allergy can significantly change prescribing patterns. This may result in the application of broad-spectrum antibiotics for common infections amenable to treatment with beta-lactam antibiotics.

The vast majority of patients with penicillin allergy never receive formal testing, in part because the gold standard for testing for penicillin allergy is laborious. 

• Standard testing for penicillin allergy begins with a percutaneous skin test, followed by a second test at the more sensitive intracutaneous layer, and concludes with an oral drug challenge. Previous research has found that more than 90% of adults with penicillin allergy presenting to the ED had a negative result on skin testing.
• The current study suggests a 17-item questionnaire completed by parents of children with a history of penicillin allergy can successfully identify children with a low risk for true allergy.
• Implications for the Healthcare Team: Every new entry added to a patient's list of medication allergies is usually present for a very long time. The current study suggests we should look at the list of medication allergies more critically to avoid limiting therapeutic options for patients.