Acne: Antibiotics may mean more sore throats

23rd November 2011 - Young adults taking oral antibiotics for acne were more than three times more likely to complain of sore throats than people who weren't, new studies show.

Around 80% of teenagers in the UK get some form of acne and it affects many adults too.

Acne and the use of oral antibiotics to treat it are so common that these patients represent "an ideal group in which to study the effects of long-term antibiotic use", University of Pennsylvania researchers in the US write.

Their findings are published in the Archives of Dermatology.

"People taking antibiotics for acne tend to be on them for months, if not years," says study researcher Dr David Margolis, a professor of dermatology.

The basic premise was that the use of long-term antibiotics might change the mix of bacteria in the throat, perhaps leading to a sore throat. It turns out it's not that simple.

Antibiotics and sore throats

A few earlier studies have suggested a connection between antibiotic therapy for acne and an increased risk of a sore throat. However, the new research is the first that follows patients over time, Dr Margolis and colleagues write.

The researchers conducted two studies. The first study looked at college students who each met with a researcher at a single visit in January and February 2007.

In this study, 10 of 15 students taking oral antibiotics for acne reported having a sore throat in the previous month, while only 47 of 130 students who had acne but weren't on oral antibiotics did.

The second study followed a separate group of almost 600 students for several visits over the 2007-2008 school year. Of that group, 36 took oral antibiotics for acne, while 96 used topical antibiotics for acne.

Just over 11% of the students taking oral antibiotics for acne said they had gone to the campus health centre for a sore throat, compared to only around 3% of the other students. The students using topical antibiotics were no more likely to report having a sore throat than those who weren't on any antibiotic therapy.

Checking for sore throats

As well as asking the students about whether they'd had sore throats, the researchers also checked them for streptococcal (strep) bacteria. Only about 10% of sore throats are caused by bacterial infections, the researchers write, but of these, strep causes 90%.

Fewer than 1% of the students had streptococcal infections, "which was a little shocking to us", Dr Margolis says.

That left the researchers without a clear answer for the increased frequency of sore throats.

Although they thought that perhaps the antibiotics might change the balance of bacteria, which could make the students more susceptible to sore throats, this research didn't prove that.

For now, Dr Margolis says doctors and patients have to consider the "risks versus the benefits of using long-term oral antibiotics in acne patients".

Dr Diane Thiboutot, a Penn State dermatology professor, says the new findings "add to the confusion" about the role of antibiotics in sore throats.

Some dermatologists, concerned that long-term use could lead to antibiotic resistance, prescribe alternatives when possible, Dr Thiboutot says, calling that "a good thing".
The biggest challenge, she says, is that topical antibiotics can cause excessive dryness, and patients think it's just easier to take a tablet.