Rosacea has been treated by antibiotic therapy for over 50 years.* Tetracyclines (tetracycline hydrochloride and oxytetracycline) first became available in 1953, followed by doxycycline in 1967 and minocycline in 1972 and have become the most commonly prescribed first -line systemic antibiotic treatment for acne and rosacea. All tetracyclines are antimicrobials that exert a bacteriostatic effect by interfering with protein synthesis on the 30S ribosomal subunit. Additionally, these agents exert anti-inflammatory properties.+
No doubt this continued use of antibiotic therapy for rosacea is because of the success in reducing rosacea inflammation and controlling it which has been accepted as one of best methods in the treatment of rosacea. However, some of the long term effects of antibiotic treatment may possibly result in bacterial overgrowth, antibiotic resistance, candida albicans, many side effects due to the long term use of this therapy which may lead to gram-negative folliculitis.
Rosacea has been associated with at least four different types of bacteria:
Helicobacter Pylori**
Chlamydophila pneumoniae#
Propionibacterium^
Bacillus oleronius***
Medical reports published at pubMed have associated rosacea with bacteria for some time time now and one theory on the cause of rosacea is that bacteria is involved and the use of antibiotics in treating rosacea has a long history. For years antibiotics were used as a secondary treatment, however, recently it is now used as a first line therapy. (See Rosacea 101, Chapter 5, Treatment, page 22)
Long term use of antibiotics may lead to two problems associated with bacteria and at least one fungus.
Bacterial Overgrowth
An article by Cathy Wong discusses how bacterial overgrowth in the small intestine can cause many health problems. One of the causes listed is taking antibiotics which most rosaceans have done. She discusses several natural methods on how to treat bacterial overgrowth. If you think that bacterial overgrowth may be a problem for you I suggest you read her article. How do you know if you have bacterial overgrowth? There are some tests to take to confirm it, for instance, taking bacterial cultures of small intestine fluid, or the lactulose hydrogen breath test.
Some signs and symptoms of bacterial growth are:
abdominal bloating and gas after meals
pain
constipation
chronic loose stools or diarrhea -
(studies have found 48% to 67% of people with chronic diarrhea had bacterial overgrowth. soft, foul-smelling stools that stick to the bowl)
fatigue - megaloblastic anemia due to vitamin B12 malabsorption
depression
nutritional deficiency despite taking supplements
weight loss
abdominal pain
mucus in stools
bloating worse with carbs, fiber, and sugar
Some of the causes of bacterial overgrowth are:
Decreased motility in the small intestine - caused by excess dietary sugar, chronic stress, and conditions such as diabetes, hypothyroidism, and scleroderma. In the United States, up to 40% of chronic diarrhea in people with diabetes is associated with bacterial overgrowth.
Hypochlorhydria - as people get older, the amount of stomach acid they secrete decline. Because stomach acid is acidic and helps to kill bacteria in the small intestine, if there is less stomach acid, bacteria are more likely to proliferate. Another very common cause of hypochlorhydria is due to excessive use of antacids.
Structural abnormalities in the small intestine - gastric bypass surgery, small intestinal diverticula, blind loop, intestinal obstruction, and Crohn's disease fistula are some of the structural causes of bacterial overgrowth.
Other causes include immune deficiency, stress, certain medications such as steroids, antibiotics, and birth control pills, inadequate dietary fiber, and pancreatic enzyme deficiency.
Treatments for bacterial overgrowth:
Diet - Low carbohydrate diet (like the Rosacea Diet)
Eradicate unfriendly bacteria in the small intestine using herbs such as peppermint oil.
Replace - Bacterial overgrowth impairs friendly bacteria ("probiotics") and digestive enzymes.
Betaine Hydrochloride
Herbs such as:
enteric coated peppermint oil
Grapefruit seed extract -
(for people who don't like taking capsules, grapefruit seed extract can be found in liquid form. Add a few drops to a glass of water and drink in between meals)
Oregano oil capsules
Garlic
Flaxseed Oil
Berberine - goldenseal, oregon grape
Olive leaf extract
Pau d'arco
Click here for a detailed list of natural treatments for rosacea.
Source:
Natural Remedies for Bacterial Overgrowth, Your Guide to Alternative Medicine.
Cathy Wong
Side Effects of Long Term Use of Antibiotics
Some of the well known side effects of long term use of antibiotics are:
Teratogenic effects
Tooth discoloration and alteration of bone growth if used by patients 12 years of age
Photosensitivity
Gastrointestinal distress
Uncommon and minocycline-specific
Vertigo
Hyperpigmentation
Lupus-like syndrome/autoimmune hepatitis
Changes in bacterial microflora
Gram-negative folliculitis
Vaginal candidiasis
Antibiotic resistance
Can reduce future treatment options
Can induce cross-resistance
Can be transferred from commensal to pathogenic microorganisms
(source: CollaGenex Pharmaceuticals, Rosacea Today)
(See also, Rosacea 101, Appendix M, Antibiotics, page 201)
Antibiotic Resistance
The medical community has become increasingly aware of the problem of antibiotic resistance with long term use of oral antibiotics. “The risks of long-term topical and systemic antibiotic use include the emergence of antibiotic-resistant bacteria and the suppression of normal bacterial flora, leading to overgrowth of pathogenic organisms such as Candida species and Clostridium difficile."
Source:
Antibiotic Treatment of Acne May Be Associated With Upper Respiratory Tract Infections Margolis DJ, Bowe
WP, Hoffstad O, Berlin JA Archives of Dermatology, 2005;141(9):1132-1136
"Because widespread and long-term use of antibiotics has led to the emergence of resistant bacteria, dermatologists are now increasingly forced to seek alternate treatment strategies." +
According to this research patent application by Richard Gallo, "Oral and topical antibiotics are effective in treating rosacea yet resistance to the antimicrobial activity of commonly used antibiotics is high, approaching 80%."
Candida Albicans
Candidiasis Cutaneous around the mouth
Image - A.D.A.M.
Candida albicans (a fungus) and rosacea have been linked in at least one research paper. One report said that a “patient was treated with intermittent pulses of itraconazole for the candidasis and doxycycline initially before being substituted with isotretinoin 6 months later for the rosacea.” and the outcome was that “the patient’s candidiasis responded well and has been in remission for 3 months while his rosacea continues to improve.”
Source:
Autosomal Dominant Familial Chronic Mucocutaneous Candidiasis Associated with Acne Rosacea
HL Ee, HH Tan, SK Ng; Ann Acad Med Singapore 2005; 34:571-4
"The use of invasive devices and broad spectrum antibiotics has increased the rate of candidal superinfections." ##
(See also, Rosacea 101, Appendix L Candida Albicans, page 199)
CANDIDA and the ANTIBIOTIC SYNDROME
By Walter Last
SIBO
Small Intestinal Bacterial Growth has been associated with rosacea. Click Here for More Info
Oracea™
You might want to consider taking Oracea™ (10 mg of timed released doxycycline and 30 mg of immediate release doxycycline) which is claimed reduces the antibiotic resistance which has been seen in using high dose doxycycline and other antibiotics.
Doxycycline
It has been noted by one report that "resistance to doxycycline can occur in a few days, with resistant bacteria in abundance after just seven days of treatment with 100 mg doxycyline daily," though this report wasn't about Oracea (or low dose timed released doxycycline) but instead about high dose doxycycline.
Topical Taurine Bromamine (TauBr)
You might consider using Topical Taurine Bromamine for rosacea if you are suffering from antibiotic resistance. More Info
Gram Negative Folliculitis
Usually people who had Gram-negative folliculitis are they who had complications with acne vulgaris and rosacea that develops in patients who have received systemic antibiotics for prolonged periods. More info.
Cooling Inflammation might prove helpful for you.
H Pylori as a Factor in Rosacea
Endnotes
* Rosacea 101, Appendix M, Antibiotics, page 201
+ Common and Alternate Oral Antibiotic Therapies for Acne Vulgaris: A Review
Journal of Drugs in Dermatology, September 2007, Vol. 6, Issue 9; Kathani Amin MD, Christy C. Riddle MD, Daniel J Aires MD, Eric S. Schweiger MD
Division of Dermatology, Department of Internal Medician, KUMC, Kansas City, KS
**Rosacea 101, Appendix C, page 167
# Rosacea 101, Appendix D, Theory 6, Bacteria, page 169
^ Rosacea 101, Appendix R, page 215
*** NRS Report, October 30, 2007
##Candida sepsis following transcervical chorionic villi sampling.
A Paz, R Gonen, and I Potasman
Infectious Diseases, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Hafa, Israel. |
