INTRODUCTION
Therapeutic Challenge
How can we ensure dermatologists practice enhanced antibiotic stewardship to combat antimicrobial resistance and negative consequences of microbiome dysbiosis?
Solution
We developed a mnemonic ENLIGHTEN to help healthcare providers and patients understand sarecycline's features (Figure I). Sarecycline is a novel narrow-spectrum, anti-inflammatory, third-generation tetracycline antibiotic used to treat acne vulgaris.1 It is Food and Drug Administration approved to treat acne in patients 9 years of age and older, and has demonstrated 3-week early onset of action with efficacy decreasing acne on both the trunk and face. Sarecycline has high antimicrobial activity against the Gram-positive anaerobe Cutibacterium acnes, which decreases its propensity to induce antibiotic resistance. It inhibits protein translation in C. acnes, but unlike other tetracyclines, sarecycline directly contacts messenger RNA in the ribosome due to a large C7 moiety in its chemical structure.2 This extramolecular contact generates greater bacteriostatic effect against C. acnes and reduces antibiotic resistance.3 Broad-spectrum tetracyclines are available to treat acne, but have more severe side effects including nausea, vomiting, and vaginal candidiasis. Gastrointestinal adverse effects (ie, gut dysbiosis) are uncommon with sarecycline due to its decreased activity against Gram-negative bacilli in the human intestinal microbiome.1 Sarecycline has an established 12-month safety profile. Patients are more likely to comply with sarecycline since it is dosed by weight once daily instead of twice.
Precision/personalized medicine in dermatology requires renewed enlightenment about antibiotic stewardship, hence the mnemonic ENLIGHTEN condenses sarecycline information to aid dermatologists in improving stewardship practice and communication with our patients.
How can we ensure dermatologists practice enhanced antibiotic stewardship to combat antimicrobial resistance and negative consequences of microbiome dysbiosis?
Solution
We developed a mnemonic ENLIGHTEN to help healthcare providers and patients understand sarecycline's features (Figure I). Sarecycline is a novel narrow-spectrum, anti-inflammatory, third-generation tetracycline antibiotic used to treat acne vulgaris.1 It is Food and Drug Administration approved to treat acne in patients 9 years of age and older, and has demonstrated 3-week early onset of action with efficacy decreasing acne on both the trunk and face. Sarecycline has high antimicrobial activity against the Gram-positive anaerobe Cutibacterium acnes, which decreases its propensity to induce antibiotic resistance. It inhibits protein translation in C. acnes, but unlike other tetracyclines, sarecycline directly contacts messenger RNA in the ribosome due to a large C7 moiety in its chemical structure.2 This extramolecular contact generates greater bacteriostatic effect against C. acnes and reduces antibiotic resistance.3 Broad-spectrum tetracyclines are available to treat acne, but have more severe side effects including nausea, vomiting, and vaginal candidiasis. Gastrointestinal adverse effects (ie, gut dysbiosis) are uncommon with sarecycline due to its decreased activity against Gram-negative bacilli in the human intestinal microbiome.1 Sarecycline has an established 12-month safety profile. Patients are more likely to comply with sarecycline since it is dosed by weight once daily instead of twice.
Precision/personalized medicine in dermatology requires renewed enlightenment about antibiotic stewardship, hence the mnemonic ENLIGHTEN condenses sarecycline information to aid dermatologists in improving stewardship practice and communication with our patients.
DISCLOSURES
Dr. Emmy Graber has served as a speaker, consultant and advisor for Almirall. Dr. Christopher G. Bunick has served as an investigator, consultant, and speaker for and received honoraria from Almirall. Almirall has not provided any financial support for this manuscript. Dr. Jordan Borash has no conflicts of interest.
REFERENCES
1. Zhanel G, Critchley I, Lin LY, Alvandi N. Microbiological profile of sarecycline, a novel targeted spectrum tetracycline for the treatment of acne vulgaris. Antimicrob Agents Chemother. 2018;63(1):e01297-18. doi: 10.1128/AAC.01297- 18. PMID: 30397052; PMCID: PMC6325184.
2. Batool Z, Lomakin IB, Polikanov YS, Bunick CG. Sarecycline interferes with tRNA accommodation and tethers mRNA to the 70S ribosome. Proc Natl Acad Sci USA. 2020;117(34):20530-20537.
3. Graber, E. M. Treating acne with the tetracycline class of antibiotics: A review. Dermatological Reviews. 2021; 2:1-10.
2. Batool Z, Lomakin IB, Polikanov YS, Bunick CG. Sarecycline interferes with tRNA accommodation and tethers mRNA to the 70S ribosome. Proc Natl Acad Sci USA. 2020;117(34):20530-20537.
3. Graber, E. M. Treating acne with the tetracycline class of antibiotics: A review. Dermatological Reviews. 2021; 2:1-10.
AUTHOR CORRESPONDENCE
Emmy Graber MD MBA egraber@dermboston.com
