Macrolides

The macrolide antibiotics can also be useful in treating acne. This family of antibiotics works by binding irreversibly to the 50S ribosomal subunit thus inhibiting translocation during protein synthesis. Erythromycin and clindamycin are members of the macrolide family that are commonly used in acne. Both are used alone or in conjunction with benzoyl peroxide as a combination product. When given orally, erythromycin is administered at 500 mg twice daily. Erythromycin can and should be taken with food as it commonly causes gastrointestinal upset. It is safe in pregnancy and in lactating women, although erythromycin estolate should be avoided in these groups as it may cause cholestatic jaundice. Erythromycin inhibits the cytochrome P450 system thus causing reduced clearance of theophylline, warfarin, carbamazepine, and cyclosporine (70,72). Concomitant use of these medications should be avoided.