INTRODUCTION
Antibiotics are among the most frequently prescribed medications in clinical medicine and have long been central to dermatologic practice, particularly for the management of chronic inflammatory conditions such as acne and hidradenitis suppurativa. Although their antimicrobial and anti-inflammatory properties provide clinical benefit, accumulating evidence reveals that antibiotic use, especially when prolonged or broadly targeted, can lead to unintended and sometimes serious systemic consequences. Chief among these is the disruption of the gut microbiome, a diverse ecosystem of commensal microorganisms that play a vital role in immune regulation, metabolic homeostasis, epithelial barrier maintenance, and neurologic function.1 Microbiota dysbiosis is the primary mechanism through which antibiotics contribute to chronic disease development. Antibiotic-induced dysbiosis can persist well beyond the treatment window, setting the stage for chronic diseases ranging from obesity and diabetes to autoimmune disorders and neuropsychiatric conditions. Of particular concern is the growing recognition that antibiotics can impair the immune system’s ability to respond effectively to vaccinations and immunotherapies. Both pediatric and adult studies have shown that recent antibiotic exposure is associated with reduced antibody titers following routine vaccinations and diminished efficacy of immune checkpoint inhibitors in cancer. Additionally, the widespread and often inappropriate use of antibiotics in dermatology has contributed to the global crisis of antimicrobial resistance (AMR), with Cutibacterium acnes strains exhibiting alarming rates of resistance to commonly used agents such as macrolides and clindamycin. Beyond microbiome disruption and resistance, antibiotics are also implicated in a range of serious adverse drug reactions, including drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, Stevens-Johnson syndrome, and autoimmune hepatitis. In rare cases, they may even trigger autoimmune bullous diseases or cause idiopathic intracranial hypertension. This manuscript reviews the expanding landscape of systemic effects associated with antibiotic use, particularly in dermatologic settings, and underscores the need for improved antibiotic stewardship.
