Antibiotic Stewardship and Emerging Resistance: Insights from the 2025 Winter Clinical Dermatology Conference

Theodore Rosen, MD

Photo courtesy of dermsquared

At the 2025 Winter Clinical Dermatology Conference, Ted Rosen, MD, of professor of dermatology at Baylor College of Medicine, delivered an urgent and insightful presentation on antibiotic stewardship and the growing threat of antimicrobial resistance (AMR). His session, Antibiotic Therapy: 2025 and Into the Future, underscored the critical need for responsible antibiotic use in dermatology to combat the accelerating crisis of drug-resistant infections.

The Rising Threat of Antimicrobial Resistance

Dr Rosen highlighted the alarming trajectory of AMR, emphasizing that bacterial evolution, horizontal gene transfer, and selective pressure from antibiotic overuse are driving resistance at an unprecedented pace. According to global estimates, AMR was responsible for 1.3 million deaths in 2019, and projections indicate that by 2050, this number could rise to 2 million annually, particularly impacting those over 50 years old. Staphylococcus aureus remains the leading cause of mortality, but resistance is emerging in a broad spectrum of pathogens.

Challenges in Dermatologic Antibiotic Use

Dermatologists frequently prescribe antibiotics for conditions such as acne, rosacea, and impetigo. Dr Rosen cautioned against reflexive use of mupirocin, citing rising resistance rates, with some regions reporting resistance levels as high as 40%. Alternative topical agents, such as ozenoxacin, may provide effective options for resistant cases.

For acne and rosacea, extended-release formulations of doxycycline and minocycline remain viable systemic options, but their use must be judicious to prevent further resistance development. Dr Rosen reinforced the importance of prescribing antibiotics only when truly necessary and for the shortest effective duration.

Principles of Antibiotic Stewardship

To mitigate AMR, Dr Rosen outlined key principles of antibiotic stewardship:

• Targeted Therapy: Use antibiotics only when absolutely indicated, guided by culture and susceptibility testing when possible.
• Optimized Dosage and Duration: Prescribe the appropriate antibiotic at the correct dose and for the shortest effective duration.
• Alternatives to Antibiotics: Consider nonantibiotic treatments where applicable, such as topical antiseptics or novel therapies.
• Regular Reassessment: Evaluate treatment efficacy and discontinue antibiotics when no longer necessary.

Future Strategies and Innovations

Dr Rosen reviewed promising advancements in combating AMR, including:

• Multitarget Antibiotic Development: Novel drugs designed to impair multiple bacterial targets simultaneously.
• Efflux Pump and Enzyme Inhibitors: Agents such as nilotinib and nacubactam show potential in overcoming bacterial resistance mechanisms.
• Bacteriophage Therapy: Already in clinical use in parts of Europe, phage therapy is being explored as an alternative to traditional antibiotics.
• Antimicrobial Antibodies and Vaccines: Expansion of prophylactic and therapeutic vaccines may play a crucial role in AMR prevention.

A Call to Action

Dr Rosen’s presentation served as a wake-up call for dermatologists to recognize their role in preserving antibiotic efficacy. The rise of resistant infections is not a distant threat—it is a present-day crisis requiring immediate and sustained efforts in stewardship and innovation.