From the Guidelines
Cutibacterium (formerly Propionibacterium) infections are typically treated with oral antibiotics, with clindamycin being a recommended option, as it has excellent bioavailability and is effective against Cutibacterium acnes 1. For mild to moderate cutaneous infections, topical treatments may be sufficient, but for more severe or systemic infections, oral antibiotics are necessary.
- The choice of antibiotic should be based on susceptibility and potential drug-drug interactions, with clindamycin being a suitable option for Cutibacterium acnes infections 1.
- The use of oral antibiotics, such as tetracycline-class antibiotics, has been associated with rising rates of antibiotic resistance among Cutibacterium acnes isolates, as well as disruption of the normal flora and increased rates of other infections 1.
- In cases involving prosthetic joints or implants, surgical debridement or removal of the infected hardware may be required alongside antibiotic therapy, with combination therapy with rifampin and another antibiotic being a possible treatment option 1.
- The treatment course for Cutibacterium infections is often longer than for other bacterial infections, due to the slow-growing nature of the bacterium and its ability to form biofilms, with treatment durations of 3-6 months or more being common 1.
- It is essential to select the most appropriate antibiotic for the specific infection, taking into account factors such as antibiotic resistance and potential side effects, to ensure effective treatment and minimize the risk of complications 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Microbiology Clindamycin is active in vitro against most isolates of Propionibacterium acnes; Although clindamycin phosphate is inactive in vitro, rapid in vivo hydrolysis converts this compound to the antibacterially active clindamycin. Clindamycin inhibits bacterial protein synthesis by binding to the 23S RNA of the 50S subunit of the ribosome. Clindamycin is bacteriostatic
The treatment for Cutibacterium (formerly Propionibacterium) infections may include clindamycin, as it is active in vitro against most isolates of Propionibacterium acnes and inhibits bacterial protein synthesis. However, the clinical significance of this activity is unknown 2.
From the Research
Treatment Options for Cutibacterium Infections
- The treatment for Cutibacterium (formerly Propionibacterium) infections typically involves the use of antimicrobial agents, such as clindamycin and erythromycin 3, 4, 5.
- However, the emergence and spread of resistance among Cutibacterium species to these antimicrobials has raised concerns about their long-term effectiveness 3, 6.
- Combination therapies, such as topical retinoid, benzoyl peroxide, or azelaic acid, may be used in conjunction with clindamycin or erythromycin to improve treatment outcomes 3.
- In cases of prosthetic joint infection, treatment may involve a combination of medical and surgical interventions, including synovectomy or complete revision, and antibiotic therapy for an extended period of time 5.
Antimicrobial Susceptibility Patterns
- Studies have shown that Cutibacterium acnes isolates exhibit varying levels of resistance to different antimicrobials, including clindamycin, erythromycin, azithromycin, tetracycline, and doxycycline 6.
- The resistance rates of these antimicrobials were found to be higher in patient groups compared to control groups, with the exception of erythromycin 6.
- Non-antibiotic agents, such as salicylic acid, N-acetylcysteine, and isotretinoin, have been shown to have anti-microbial effects against Cutibacterium acnes and may be useful as adjuvants in treating acne vulgaris 7.
Emerging Therapies
- The use of non-antibiotic agents, such as those mentioned above, may provide an alternative approach to reducing antibiotic resistance and improving treatment outcomes for Cutibacterium infections 7.
- Further research is needed to fully understand the efficacy and safety of these emerging therapies and to determine their potential role in the treatment of Cutibacterium infections.