Topical antibiotics

There are a number of different brands of topical metronidazole, some of which come in a gel formulation and others in cream. Again, the Electronic Medicines Compendium will give specific advice about the use of each product. In general the method of application is similar to that of azelaic acid. The face should be gently cleansed and dried before an application of a thin layer of the product is gently massaged into the face. It should be used twice daily, but unlike azelaic acid should not be used constantly for more than 9 weeks. Because metronidazole becomes less effective when exposed to UV light, individuals should be warned not to go out in the sunshine whilst using the product.

It can act as an irritant and one of the side effects is skin burning and soreness. It may make the eyes water if it is applied too closely or gets into the eye by mistake. For some there are other undesirable effects which include a metallic taste in the mouth, tingling or numbness of the extremities, nausea and exacerbation of the rosacea. It is recommended that metronidazole should be discontinued in pregnancy and whilst breast feeding.