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Cu toții ne dorim un bun și plin de realizări, liniștit și împlinit, curat și frumos! Propionibacterium acnes P acnes is involved in acne pathogenesis and its eradication requires treatment with antibacterial substances, especially antibiotics. The use of antibiotics in acne was associated with the development of P acnes resistance to antibiotics and the possibility to transfer the resistance factors to other bacterial species.

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In this paper we present the main causes responsible for the development of antibiotic resistance and the measures to preventit. Propionibacterium acnes and antibiotic resistance — impact on public health RoJCED ; 2 warts treatment dubai Acneea reprezintă o afecțiune inflamatorie cronică, frecventă la persoana adultă și asociată cu un important impact negativ asupra calității vieții pacienților. Propionibacterium acnes P acnes este implicat în patogenia acneei și necesită un tratament antibacterian, în special cu preparate antibiotice.

Utilizarea preparatelor antibiotice în acnee a fost asociată cu posibilitatea dezvoltării rezistenței lui P acnes la antibiotice și cu transferul factorilor de rezistență la alte specii bacteriene. În acest articol prezentăm principalele cauze care au condeus la dezvoltarea rezistenței lui P acnes la antibiotice precum și măsurile care se impun warts treatment dubai prevenirea instalării rezistenței la antibiotice.

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Antibiotics represent an important option in acne treatment for many clinicians 3, 4and because acne has the caracteristics of a ,chronic disease, 5,6the treatment strategy must comprise on a combination of atack treatment and maintenance therapy 7. Propionibacterium acnes P. P acnes, previously classified as Corynebacterium parvum, has been implicated in the pathogenesis of acne for more than years, starting with Unna 11 in Antimicrobial resistance is a major problem and is an important issue to consider in acne treatment 12 and is a significant public health issue The main contributors in the development of antibiotic resistance are the pharmaceutical industry, the agriculture and animal husbandry industry, patients, and healthcare providers The importance of antibiotic resistance is highlighted by Financial Times 15respectively ,With increasing urgency, national and international health authorities are calling for physicians to limit antibiotic use.

Warts treatment dubai of P acnes resistance to antibiotics The development of resistance to antibiotics is a direct results of use and abuse of antibiotics 16and unfortunately the antibiotics use in acne treatment lacks bacterial specificity and has an important risk to generate resistance to antibiotics bacteria In the last few decades Propionibacterium acnes P.

A paper from 20 showed that in more than patients with acne there was no evidence of antibiotic resistant P acnes, and it was believed that P acnes is incapable of developping antibiotic resistance.

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But, shortly after the introduction on the market of topical formulations of erythromycin and clindamycin, P. Acnes's resistance to antibiotics was firs noted InCrawford 22 reported the first indication of resistance to topical antibiotics in acne, and in the eighties P. Acnes was reported to be resistant to tetracycline Impact warts treatment dubai P acnes resistance to antibiotics The most important issues regarding P.

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In respect of the topical antibiotics, the resistance warts treatment dubai is limited on the treated area but with oral antibiotics, the resistance can develop in all body area The effects of antibiotic resistance of P acnes in patients with acne are represented by a reduction of clinical response to antibiotic therapy, a potential increase of P acnes pathogenicity and, a multidisciplinary implication, the possibility of resistance transfer to other pathogenic organisms The presence of P warts treatment dubai resistant to antibiotics will have warts treatment dubai important effect and impact on treatment outcome 26, 27respectively reduced response or no response or relapse shortly after the treatment 23, 26, 27 Presence of P acnes resistant to clindamycin, erythromycin and cyclines is strong connected with no clinical response or frequently relapses after the treatment 23, 28, 29 According to 30respectively a systematic review of 50 clinical trials with topical antibiotics, there is a gradual decrease of efficacy of topical erythromycin in acne both on inflammatory and non-inflammatory lesionsprobably connected with the warts treatment dubai of antibiotic resistance of P acnes.

Another problem 31 with P acnes resistance to antibiotics is represented by the implications for other infections, respectively the possibility of transmission of factors conferring resistance to other bacteria 26, This problem can be the direct result of development of resistant coagulase-negative staphylococci CNS on warts treatment dubai local and distant anatomical sites in patients with acne treated with topical erythromycin 26, 35, 36and CNS has been shown to transfer resistance to the more pathogenic S.

The modalities of dissemination are represented by person-to-person contact and the spreadding of resistant strains can be carried out by the treatting physician, family or friends 38, 39, An important issue is related with the persistence of antibiotic resistance of P acnes after the antibiotic treatment is stopped, and the data are divergent, respectively some authors suggest that resistant isolates disappear after antibiotic treatment is stopped 41 other data suggest that resistance persists and can be reactivated rapidly An alarming fact is represented by an increasing number of reports of systemic infections 43 caused by resistant P.

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Factors associated with P acnes resistance to antibiotics The percentage of acne patients carrying P. Countries with higher rates of oral antibiotic use ,prescribing practice, hpv causes autism acne had significantly higher rates of resistance of P acnes 40 and resistance to commonly used antimicrobial drugs is remarkably higher in countries where antibiotics are not restricted Severity of acne and sales of antibiotics are other factors involved in development of P acnes resisteance to antibiotics, respectively resistance is more frequent in patients with moderate-to-severe acne and in countries with high outpatient antibiotic sales Acnes before starting any acne therapy, is a valuable proof that resistant strains can be transmissible via humanto-human contact 40possibly among family and friends.

An alarming fact is represented by the existence of resistant strains of P acnes in younger siblings and children of patients with acne 38 and the implication to have resistant strains of P acnes colonizing the face 25 of 39 tested Topical erythromycin warts treatment dubai topical clindamycin the most commonly antibiotics used in acne are the main ,culprits, for antibiotic resistance of P acnes 23, 53, 54, 55, Monotherapy with topical antibiotic warts treatment dubai be prohibited because resistant P.

Other factors which can be connected with the possibility of developing warts treatment dubai antibiotic resistance are previous treatment 41, 40, 29the amount of a warts treatment dubai antibiotic used 58, 59 and prescribing practices 39, Ross et al 39 showed that the mechanism involved in erythromycin and clindamycin resistance is connected with four phenotypes with cross-sensitivity to warts treatment dubai, lincosamide and streptogramin B Como identificar el papiloma humano en la boca antibiotics.

Mutations in genes encoding 23S and 16S represent the molecular basis of resistance, and are widely distributed In contrast, additional resistant strains without these mutations have also been identified and the mechanisms underlying their reduced antibiotic susceptibility remain to be elucidated 39, Resistance to clindamycin develop in other ways, with the most common being the bacterium changing the binding site 62, On the other hand, tetracycline resistance is associated with a single G-C transition in the 16 S rRNA of the small ribosomal subunit 64 and there is an association between resistance to tetracycline, doxycycline and minocycline How warts treatment dubai we prevent the antibiotic resistance?

The strategies and guidelines for warts treatment dubai limitation of antibiotic resistance 38 will change the prescribing practice the levels of resistance is strongly correlated with the levels of antibiotic use and will prevent transfer of resistance factors to other bacteria.

According to Warts treatment warts treatment dubai guidelines, oral antibiotics should be used for inflammatory acne only during the induction phase and then discontinued during a maintenance phase with topical therapy The main objectives of the guidelines are improvement in the care of acne patients, reduction of serious conditions and scarring, promotion of adherence and reduction of warts treatment dubai resistance. Pathogenesis of acne is complex and multifactorial and a combination of different warts treatment dubai of drugs is the best practical approach.

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The most useful combination, targeting the growth of P acnes inflammation and comedogenesis, is represented by antibiotics WITH retinoids Because the antimicrobials and topical retinoid have complementary mechanisms of action, the combination will have a greater efficacy in reducing number of inflammatory and non-inflammatory lesions compared to monotherapy 68, 69, 70, Another advantage is the fact that patients on combination therapy show faster signs of improvement 72, 73, 74and the warts treatment dubai onset of action is connected with better adherence and will reduce the amount of antibiotic exposure and risk of P.

Acnes resistance. We must not forget that poor outcome of treatment may be caused by poor adherence 75, Rates of adherence with acne treatment are higher in adult females, compared with both males and adolescents 77 and the main factors involved in adherence are patient education, use of combination therapies, patient satisfaction, response to treatment and side-effects.

In order to have a better adherence we must simplify treatment regimens, decrease doses per day and number of medications used, use medication reminders, following up by phone, encourage patients to join warts treatment dubai warts treatment dubai and educate patients during the consultations 78, Benzoyl peroxide BPO has been used since the s due to its antibacterial, keratolytic, and comedolytic properties 80, 14 and is a broadspectrum antibacterial agent that comes in many formulations and works through the interaction of oxidized intermediates with various constituents of microbial cells Very important, until now despite its widespread use bacterial resistance has not been reported.

Topical benzoyl peroxide or azelaic acid may be added to antibiotic therapy to reduce the potential for developing P. The combination benzoyl peroxide plus a topical retinoid is often used in conjunction with antibiotics to prevent or eliminate the development of antibiotic-resistant P.

Acnes growth 83, 84 and decreases the risk of resistance 85, 57and the washing with products containing BPO effectively reduces P.

Warts treatment dubai and systemic antibiotics should be used in combination with a topical warts treatment dubai, since retinoids target acne precursor lesions microcomedones and have a significant effect on comedones Retinoids do not contribute to antibiotic resistance and are a part of eco-responsible acne treatment 55, 38, Combination therapy involving a topical retinoid plus an antimicrobial is the recommended first-line approach and numerous clinical studies showing improved efficacy of this approach 38, By tailoring the choice of antimicrobial and duration of antibiotic use, the combination topical retinoid plus an antimicrobial can be used for almost all patients with acne, providing results that are faster and superior to antibiotic therapy alone 4, Combination therapy is likely to have a more significant effect because it targets 3 major areas of acne pathophysiology: P.

Combination therapy aimed at eradicating P. Current recommendations also include limiting the duration of systemic antibiotic use, avoiding the use of topical and systemic antibiotics together, adding BPO to retard emergence of resistant bacteria, including a topical retinoid to improve outcomes and using topical retinoids for maintenance therapy adding BPO if warts treatment dubai The current consensus is that topical antibiotics alone should not be used as monotherapy in acne because of their relatively slow onset of action and their warts treatment dubai for causing bacterial resistance Other recommendations of recently published guidelines suggest that the duration of antibiotic therapy can be limited to 3 to 6 months 21, 82, 94, Conclusions Success against antimicrobial resistance requires an interdisciplinary approach, with increased microbial surveillance, judicious use of antimicrobials not only in human medicine but in agriculture and animal husbandry also, increased research on the biology of microbes and mechanisms of resistance; development of novel antibiotics and vaccines as well as rapid, point-of-care diagnostics; and, most importantly alteration of old prescribing habits 14, Acne lesions typically recur for years, and so acne is nowadays considered to be a chronic disease 1and the correct approach is atack therapy followed by maintenance therapy.

Maintenance therapy can be defined as the warts treatment dubai use of appropriate therapeutic agents to ensure that acne remains in remission Therapy is therefore tailored to the individual patient depending on the nature and severity of their acne 98, This work is licensed under a Creative Commons Attribution 4.

Can we define acne as a chronic disease? If so, how and when? Am J Clin Dermatol.

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An exploratory study of adherence to topical warts treatment dubai peroxide in patients with acne vulgaris. J Am Acad Dermatol. Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia ; Trends in the treatment of acne vulgaris: are measures being taken to avoid antimicrobial resistance?

Journal of drugs in dermatology : JDD ; Centers for Disease Control and Prevention.

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Classifications of diseases and functioning and disability. In: Classifications of diseases and functioning and disability. Vol National Center for Health Statistics; definition of disability reference. Accessed February 23, Defining chronic conditions for primary care with ICPC Fam Pract ; Jappe U.