A study of acne antibiotic resistance in Malta
L Mercieca, *J Cefai, D Micallef, *P Caruana, E Clark, M J Boffa, L Scerri, S Aquilina; Department of Dermatology, Sir Paul Boffa Hospital, Malta & *Department of Microbiology, Mater Dei Hospital, Malta
Acne is a common dermatological disease with a significant impact on the patient’s quality of life. Long courses of topical and oral antibiotics are commonly used to treat acne. However, Propionibacterium acnes (P. acnes) resistance is becoming more common as reported in various countries. There are no studies available reporting the antibiotic sensitivities of P. acnes in the Maltese population. This study therefore aimed to determine the antibiotic sensitivities of P. acnes in Maltese patients with acne. Patients were recruited from dermatology outpatient clinics both at Sir Paul Boffa Hospital and private clinics. Demographic and clinical data including previous treatments used were recorded. Swabs were taken and sent for culture and sensitivity to minocycline, doxycycline, tetracycline, clindamycin, azithromycin and co-trimoxazole. There were a total of 110 patients of which 93 had a positive culture for P. acnes. Nineteen percent (n=18) of the patients with a positive culture had resistance to at least one antibiotic. Resistance was highest with azithromycin (17%, n=16) followed by clindamycin (15%, n=14), tetracycline (2%, n=2) and doxycycline (2%, n=2). There were no resistant strains to minocycline or co-trimoxazole. This is the first study documenting antibiotic resistance in P. acnes in Malta. It is relatively low compared to other countries. Resistance to all tetracycline antibiotics is common however in our study strains resistant to doxycycline and tetracycline were sensitive to minocycline. These results may help direct the choice of antibiotic for treating patients with acne and underline the need for further studies in this area.