Classically, the clinical significance of less-sensitive strains is established by comparing the MIC or the minimum bactericidal concentration with the achievable concentration of the antibiotics in the body site in which the organism is proliferating. Unfortunately, no data exist for antibiotic levels in individual sebaceous follicles. Despite technological advances in microanalytical techniques, antibiotic levels in individual follicles have not yet been quantified. This means that no clinically relevant 'break point' has been established. Rather, we have had to resort to a much more difficult type of analysis, i.e. comparing clinical outcomes in those treated with antibiotics to which P. acnes is insensitive . Despite the difficulties of such studies, there are enough data to indicate that clinical outcomes are poor in those with 'resistant strains'. In clinical practice, one cannot obtain P. acnes antibiotic sensitivities on a routine basis. Rather, one must use clinical sense in the setting of a patient who is no longer responding to an antibiotic which was previously effective.
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