What methods are used to eliminate Brevibacterium and Propionibacterium (Propionibacteria)?

From the Guidelines

To eliminate Brevibacterium and Propionibacterium, the most effective treatment is 4-6 weeks of pathogen-specific intravenous or highly bioavailable oral antimicrobial therapy, with Penicillin G 20 million units IV q24 h or Clindamycin 600–900 mg IV q8 h being the preferred treatments for Propionibacterium acnes. The choice of antimicrobial therapy should be based on in vitro susceptibility, patient drug allergies, intolerances, and potential drug interactions or contraindications to a specific antimicrobial 1. It is essential to adjust the antimicrobial dosage according to the patient's renal and hepatic function and to monitor for efficacy and safety based on prior IDSA guidelines 1.

Some key considerations for treatment include:

• The use of Penicillin G 20 million units IV q24 h or Clindamycin 600–900 mg IV q8 h as the preferred treatments for Propionibacterium acnes 1
• The potential for hazards such as prolonged QTc interval and tendinopathy when using fluoroquinolones, and the possibility of Clostridium difficile colitis when using any antimicrobial 1
• The importance of clinical and laboratory monitoring for efficacy and safety, as well as adjusting antimicrobial dosage based on patients' renal and hepatic function 1

In terms of specific treatment regimens, the guidelines recommend:

• 4-6 weeks of pathogen-specific intravenous or highly bioavailable oral antimicrobial therapy (Table 2; B-II) 1
• Antimicrobial dosage adjustment based on patients' renal and hepatic function, and choice of antimicrobials based on in vitro susceptibility, patient drug allergies, intolerances, and potential drug interactions or contraindications to a specific antimicrobial 1

Overall, the treatment of Brevibacterium and Propionibacterium infections requires a comprehensive approach that takes into account the patient's individual needs and the potential risks and benefits of different treatment options. By following the recommended treatment guidelines and monitoring for efficacy and safety, healthcare providers can help to eliminate these infections and improve patient outcomes.

From the FDA Drug Label

Clindamycin is active in vitro against most isolates of Propionibacterium acnes; Clindamycin inhibits bacterial protein synthesis by binding to the 23S RNA of the 50S subunit of the ribosome. Doxycycline has been found to be active against... Propionibacterium acnes

The methods used to eliminate Propionibacterium are:

• Clindamycin: inhibits bacterial protein synthesis by binding to the 23S RNA of the 50S subunit of the ribosome.
• Doxycycline: inhibits protein synthesis, but the precise mechanism of action is not known.

There is no information in the provided drug labels about methods to eliminate Brevibacterium. 2 3

From the Research

Methods for Eliminating Brevibacterium and Propionibacterium

• Benzoyl peroxide is a powerful antimicrobial agent that rapidly destroys both bacterial organisms and yeasts, including Propionibacterium acnes 4, 5, 6, 7
• Topical antibiotics such as clindamycin and erythromycin have been proven to be effective against inflammatory acne vulgaris in concentrations of 1-4% with or without the addition of zinc 8, 6
• Combination therapy with benzoyl peroxide and topical antibiotics may increase the bactericidal effect of the antibiotic and reduce the potential for bacterial resistance 4, 6
• Topical retinoids may enhance the efficacy of topical antibiotics by improving their penetration 6

Efficacy of Different Treatments

• Benzoyl peroxide 5%/clindamycin phosphate 1% gel significantly reduced P. acnes levels by >1 log10/cm2 from baseline (91% inhibition) 24 hours after application 4
• Triaz 6% benzoyl peroxide special gel produced faster and significantly greater reductions in P. acnes than did the 1% clindamycin phosphate in Cleocin-T lotion 5
• 5% (w/v) benzoyl peroxide in an aqueous gel significantly reduced the surface and follicular microbial populations, including propionibacteria and Micrococcaceae, after 2 days' treatment 7

Considerations for Treatment

• Topical antibacterial therapy should be discontinued once improvement is observed, and if no improvement is observed within 6-8 weeks, the agent should be discontinued and a therapeutic switch considered 6
• The primary limitation of benzoyl peroxide for some acne vulgaris patients is cutaneous irritation or dryness 6
• Topical and oral antibacterials should not be used in combination for the treatment of acne vulgaris, since this association may increase the risk of bacterial resistance 6