A patient may also not respond to antibiotics therapy if there is P. acnes resistance (75). Antibiotic resistance is a real problem of growing concern. The overall incidence of P. acnes antibiotic resistance increased from about 20% in 1978 to approximately 62% in 1996. Resistance of P. acnes is most common for erythromycin, clindamycin, tetracycline, […]

It is important to discuss and educate patients on the potential side effects of each antibiotic in order to maximize patient compliance. Patients may express several concerns about oral antibiotic use. One of these concerns may be possible reduced efficacy of their oral contraceptives. No pharmacokinetic interaction has been demonstrated between oral contraceptive pill and […]

Trimethoprim/sulfamethoxazole is another oral antibiotic option for acne. It is administered 160 mg/800 mg twice daily. It works by inhibiting dihydrofolate reductase thus impeding purine and pyrimidine synthesis. It has a broad spectrum of antimicrobial activity, and therefore should be reserved as a second line agent or for patients with gram­negative folliculitis. Due to its […]

The oral use of clindamycin is limited since 20-30% of patients will experience diarrhea. Oral clindamycin can also cause an overgrowth of Clostridium difficile in the gut thus causing pseudomembranous colitis (72). Topical clindamycin is generally well tolerated, and is available by prescription in solution, gel, and foam formulations.

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 […]

The tetracyclines work by interacting with the 30S ribosomal subunit of bacteria, and thus inhibiting protein synthesis. Included in the tetracycline family are tetracycline, Table 6 Over-the-Counter Salicylic Acid Products Product Strength (% salicylic acid) Aveeno Clear Complexion Cleansing Bar 1% Aveeno Clear Complexion Correcting Treatment 1% Aveeno Clear Complexion Daily Cleansing Pads 0.5% Biore […]

Oral antibiotics are often administered to patients with moderate to severe acne or in patients in whom topical therapy has failed. Patients with moderate acne with scarring or those whose acne covers a large surface area making topical application difficult may also be candidates for oral antibiotics. Oral antibiotics used in acne are typically of […]

Other topical products with antimicrobial effects include azelaic acid and sodium sulfacetamide. Azelaic acid is a naturally occuring nine-carbon dicarboxylic acid. It is available for the treatment of acne in a 20% cream preparation. Azelaic acid has antimicrobial and weak anti-comedogenic effects. It reduces the production of keratohyalin granules in the pilosebaceous epithelium, thus normalizing […]

Benzoyl peroxide is a topical medication that has bactericidal effects to reduce P. acnes. It is available in both over-the-counter (Table 7) and prescription formulations as a bar soap, wash, gel or lotion in varying concentrations. The stay-on formulations of benzoyl peroxide will decrease P. acnes counts more so than the washes although both significantly […]