Ted Rosen, MD, points out pearls from his lecture Antibiotic Resistance & How to Deal With It at the 6th Annual Elevate-Derm Alliance Conference at the JW Marriott Water Street in Tampa, Florida.

In this video

Dr. Rosen opens with impetigo, stressing that clinicians need to know the resistance picture in their own locale — globally mupirocin resistance among staph and strep runs 8 to 14%, but some regions exceed 40% and even 60%. If mupirocin isn't working, he says to switch, and he predicts ozenoxacin — FDA-approved for impetigo, twice daily for five days, and every bit as effective — will become easier to obtain at a more reasonable cost. For acne and rosacea, he frames stewardship around limiting oral antibiotics to a 12-week maximum and "starting the off ramp" with a topical retinoid, antibiotic, benzoyl peroxide, or combination, so the topical takes over when the oral stops.

He points to alternatives that spare the flora entirely: sarecycline, hormonal options like spironolactone or oral contraceptives, blue and red light therapy, and the 1726 nm laser, where three treatments a month apart can buy a year of clear skin with no antibiotic. On scabies, he notes an estimated 15% of isolates worldwide are now resistant to ivermectin, permethrin, or both, and rising. His options: "go back to the future" with daily 10% precipitated sulfur for three to five days — which smells but works — or spinosad, now approved for scabies, where a single overnight application gives an 80 to 90% cure rate.

  • Impetigo: know your local mupirocin resistance rate (8–14% globally, but >40–60% in some areas); if mupirocin fails, switch — ozenoxacin is approved, twice daily for five days, and works as well.
  • Acne/rosacea: when oral antibiotics are unavoidable, cap them at 12 weeks and start a topical off ramp (retinoid, antibiotic, benzoyl peroxide, or combination) so the topical takes over.
  • Consider antibiotic-sparing acne options: sarecycline (selective, but costly), hormonal therapy, blue/red light, and the 1726 nm laser — three treatments can give a year of clear skin.
  • Scabies resistance to ivermectin and/or permethrin is now ~15% globally and rising; alternatives include daily 10% precipitated sulfur for 3–5 days or a single overnight spinosad application (80–90% cure).
  • Be a true antibiotic steward — get creative and reach for non-antibiotic options whenever possible.