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Ross M. Levy, BA; Eric Y. Huang, MD, PhD; Daniel Roling, MD; James J. Leyden, MD; David J. Margolis, MD, PhD

Arch Dermatol. 2003;139:467-471.

Objective  To estimate the prevalence and resistance patterns of Streptococcus pyogenes and Staphylococcus aureus in the oropharynx of individuals with acne who were using or not using antibiotic therapy.

Design  A cross-sectional study.

Setting  The Dermatology Department of the Hospital of the University of Pennsylvania, Philadelphia.

Patients  Patients with acne.

Main Outcome Measures  Presence or absence of S pyogenes and S aureus in the oropharynx as determined by culture and their resistance patterns to tetracycline antibiotics as determined by agar disk diffusion.

Results  Of 105 patients who participated, 42 were using oral or topical antibiotics and 63 patients were not using antibiotics. Six (10%) of those 63 not using anyantibiotics had positive S pyogenescultures compared with 13 (33%) of those successfully evaluated using antibiotics (n = 39) (prevalence risk ratio, 3.5; 95% confidence interval, 1.4-8.6; P= .003). A total of 85% of S pyogenes cultures (11/13) from those using antibiotics were resistant to at least 1 tetracycline antibiotic compared with 20% (1/5) from those not using antibiotics (P= .01). Of those not using antibiotics, 29% (18/62) had positive S aureus cultures compared with 22% (9/41) of those using antibiotics (prevalence risk ratio, 0.76; 95% confidence interval, 0.38-1.5; P= .42). No significant differences in resistance patterns of S aureus were found.

Conclusions  Streptococcus pyogenes colonization and resistance in the oropharynx are associated with antibiotic therapy in patients with acne. The clinical and long-term effects of this finding need to be studied further.

From the Departments of Dermatology (Mr Levy and Drs Huang, Roling, Leyden, and Margolis) and Biostatistics and Epidemiology (Dr Margolis) and the Centers for Clinical Epidemiology and Biostatistics (Dr Margolis) and Education and Research on Therapeutics (Dr Margolis), University of Pennsylvania School of Medicine, Philadelphia. The authors have no relevant financial interest in this article.

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