Topical antibiotics

If BPO is not tolerated, topical antibiotics particularly topical clindamycin, erythromycin or tetracycline may be used. There are concerns about antibiotic resistance and it is generally recommended that they should not be used as a monotherapy, but instead be used with a retinoid product. Long term use as a maintenance therapy should also be avoided. They have a slower onset than oral antibiotics and are less effective (Gollnick et al., 2003). Some topical antibiotic products already contain BPO and it has been shown that this combination leads to a reduced potential for developing P. acnes resistance (Eady et al., 1996).

How long to use treatment for?
All three of the topical treatments in this section need to have been used for 2 months before assessment as to their success or failure is made. During this prolonged period of time, patients will need to have support and encouragement to continue to use treatments. Concordance will be improved with regular contact to discuss how the treatments are feeling on the skin and whether there are any ongoing problems (see Helping patients make the most of their treatment). Ideally, patients should have access to telephone support.