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David J. Margolis, MD, PhD; Whitney P. Bowe, BS; Ole Hoffstad, MA; Jesse A. Berlin, ScD

Arch Dermatol. 2005;141:1132-1136.

Objective  To determine if the long-term use of antibiotics for the treatment of acne results in an increase in either of 2 common infectious illnesses: upper respiratory tract infections (URTIs) or urinary tract infections.

Design  Retrospective cohort study.

Setting  General Practice Research Database of the United Kingdom, London, England, from 1987 to 2002.

Patients  Patients with a diagnosis of acne.

Main Outcome Measure  The onset of either a URTI or a urinary tract infection.

Results  Of 118 496 individuals with acne (age range, 15-35 years) who were identified in the General Practice Research Database, 84 977 (71.7%) received a topical or oral antibiotic (tetracyclines, erythromycin, or clindamycin) for treatment of their acne and 33 519 (28.3%) did not. Within the first year of observation, 18 281 (15.4%) of the patients with acne had at least 1 URTI, and within that year, the odds of a URTI developing among those receiving antibiotic treatment were 2.15 (95% confidence interval, 2.05-2.23; P<.001) times greater than among those who were not receiving antibiotic treatment. Multiple additional analyses, which were conducted to show that this effect was not an artifact of increased health care–seeking behavior among our cohorts, included comparing the cohorts of patients with acne with a cohort of patients with hypertension and the likelihood of developing a urinary tract infection.

Conclusions  Patients with acne who were receiving antibiotic treatment for acne were more likely to develop a URTI than those with acne who were not receiving such treatment. The true clinical importance of our findings will require further investigation.

Author Affiliations: Departments of Dermatology (Dr Margolis and Ms Bowe) and Biostatistics and Epidemiology (Drs Margolis and Berlin and Mr Hoffstad), University of Pennsylvania Center for Education and Research in Therapeutics, Philadelphia. Dr Berlin is now with Johnson & Johnson Pharmaceutical Research and Development, La Jolla, Calif.

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