Topical use of antibiotics is currently a widely accepted effective and safe treatment for acne. A review of the articles published in the past 30 years revealed that topical application of antibiotics such as erythromycin, clindamycin or tetracycline showed clinical effectiveness for mild to moderate inflammatory acne, especially when they are combined with zinc, tretinoin or benzoyl peroxide, while they showed little influence on noninflammatory acne. The main mechanism of action of topical antibiotics for acne treatment is inhibition of inflammation caused by bacteria rather than a direct bactericidal effect. The adverse reactions of topical antibiotics are mostly minor and negligible, while special attention should be given to the risk of development of resistant strains of Propionibacterium acnes. The development of new antibiotics is promising and will provide a wider range of therapeutic options for refractory cases.

1.
Berson DS, Shalita AR: The treatment of acne: The role of combination therapy. J Am Acad Dermatol 1995;332:S31–S41.
2.
Pochi PE: The pathogenesis and treatment of acne. Annu Rev Med 1990;41:187–198.
3.
Thiboutot DM: An overview of acne and its treatment. Cutis 1996;57:8–12.
4.
Lyden JJ, McGinley KJ, Mills OH, Kligman AM: Propionibacterium levels in patients with and without acne vulgaris. J Invest Dermatol 1975;65:382–384.
5.
Eady EA, Holland KT, Cunliffe WJ: Should topical antibiotics be used for the treatment of acne vulgaris? Br J Dermatol 1982;107: 235–240.
6.
Webster GF, McGinley KJ, Leyden JJ: Inhibition of lipase production in Propionibacterium acnes by sub-minimal-inhibitory concentrations of tetracycline and erythromycin. Br J Dermatol 1981;104:453–457.
7.
Elewski BE, Sam M Jr, Gammon WR: In vivo suppression of neutrophil chemotaxis by systemically and topically administered tetracycline. J Am Acad Dermatol 1983;8:807–812.
8.
Thong UH, Ferrante A: Inhibition of mitogen-induced human lymphocyte proliferation responses by tetracycline analogs. Clin Exp Immunol 1979;35:443–446.
9.
Eady EA, Joanes DN, Cunliffe WJ: Topical antibiotics for the treatment of acne vulgaris: A critical evaluation of the literature on their clinical benefit and comparative efficacy. J Dermatol Treat 1990;1:215–226.
10.
Habbema L, Koopmans B, Menke HE, Doornweerd S, Boulle KD: A 4% erythromycin and zinc combination (Zineryt) versus 2% erythromycin (Eryderm) in acne vulgaris: A randomized, double-blind comparative study. Br J Dermatol 1989;121:497–502.
11.
Cook CH, Centner RL, Michaels SE: An acne-grading method using photographic standards. Arch Dermatol 1979;115:571–575.
12.
Strauss JS, Stranieri AM: Acne treatment with topical erythromycin and zinc: Effect on Propionibacterium acnes and free fatty acid composition. J Am Acad Dermatol 1984;11:86–89.
13.
Burke B, Eady EA, Cunliffe WJ: Benzoyl peroxide versus topical erythromycin in the treatment of acne vulgaris. Br J Dermatol 1983; 108:199–204.
14.
Chalker DK, Shalita A, Smith JG, Swann RW: A double blind study of the effectiveness of a 3% erythromycin and 5% benzoyl peroxide combination in the treatment of acne vulgaris. J Am Acad Dermatol 1983;9:933–936.
15.
Ellis CN, Gammon WR, Stone DZ, Heezen-Wehner JL: A comparison of Cleocin-T solution, Cleocin-T gel and placebo in the treatment of acne vulgaris. Cutis 1988;42:245–247.
16.
Shalita AR, Smith EB, Bauer E: Topical erythromycin vs clindamycin therapy for acne: A multicenter, double-blind comparison. Arch Dermatol 1984;120:351–355.
17.
Swinyer LJ, Baker MD, Swinyer TA, Swinyer TA, Mills OH Jr: A comparative study of benzoyl peroxide and clindamycin phosphate for treating acne vulgaris. Br J Dermatol 1988; 119:615–622.
18.
Wechsler HL, Kirk J, Slone J: Acne treated with a topical tetracycline preparation: Results of a one-year multi-group study. Int J Dermatol 1978;17:237–242.
19.
Tucker SB, Tausend R, Cochran R, Flannigan SA: Comparison of topical clindamycin phosphate, benzoyl peroxide, and a combination of the two for the treatment of acne vulgaris. Br J Dermatol 1984;110:487–492.
20.
Leyden J, Shalita A: Rational therapy for acne vulgaris: An update on topical treatment. J Am Acad Dermatol 1986;15:907–915.
21.
Mills OH, Kligman AM: Treatment of acne vulgaris with topically applied erythromycin and tretinoin. Acta Derm Venereol (Stockh) 1978;58:555–557.
22.
Rietschel R, Duncan BS: Clindamycin phosphate used in combination with tretinoin in the treatment of acne. Int J Dermatol 1983;22: 41–43.
23.
Mills OH, Berger RS: A double-blind evaluation of tretinoin alone and in combination with erythromycin/benzoyl peroxide in acne vulgaris. Cutis 1992;49:12–15.
24.
Knutson DD, Swinyer LJ, Smoot WH: Meclocycline sulfosalicylate: Topical antibiotic agent for the treatment of acne vulgaris. Cutis 1981;27:203–210.
25.
Kurokawa I, Akamatsu H, Nishijima S, Asada Y, Kawabata S, Kuwabata S: Clinical and bacteriologic evaluation of OPC-7251 in patients with acne: A double-blind group comparison study versus cream base. J Am Acad Dermatol 1991;25:674–681.
26.
Vogt K, Hahn H, Hermann J, Haustein UF, Blume U, Gollnick H, Orfanos CE: Antimicrobial evaluation of nadifloxacin (OPC-7251), a new topical quinolone, in acne vulgaris. Drugs 1995;49(suppl 2):266–268.
27.
Milstone EB, McDonald AJ, Scholhamer CF: Pseudomembraneous colitis after topical application of clindamycin. Arch Dermatol 1981; 117:154–155.
28.
Parry MF, Rha CK: Pseudomembraneous colitis caused by topical clindamycin phosphate. Arch Dermatol 1986;122:583–584.
29.
Rothman KF, Pochi PE: Use of oral and topical agents for acne in pregnancy. J Am Acad Dermatol 1988;19:431–432.
30.
Eady EA, Cove JH, Holland KT, Cunliffe WJ: Erytromycin-resistant propionibacteria in antibiotic-treated acne patients: Association with therapeutic failure. Br J Dermatol 1989;121: 51–57.
31.
Eady EA, Farmery MR, Ross JI, Cove JH, Cunliffe WJ: Effects of erythromycin and benzoyl peroxide alone and in combination against antibiotic-sensitive and resistant skin bacteria from acne patients. Br J Dermatol 1994;131: 331–336.
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