This article in the Drug and Therapeutics Bulletin (DTB) consider the place of topical antibacterials for acne, including the risk of bacterial resistance. The following topics are discussed:

• Acne

• Methods for grading acne severity

• Management principles

• Topical treatment options (non-antibacterial and antibacterial agents)

• Efficacy of topical antibacterials as monotherapy

• Efficacy of topical antibacterials in combination therapy (erythromycin plus benzoyl peroxide, clindamycin plus benzoyl peroxide, antibacterials with tretinoin)

• Resistance to topical antibacterials

• Guidelines

The article concluded that topical antibacterials are well tolerated, effective treatment options for mild to moderate inflammatory acne, but are no more effective than benzoyl peroxide. However, their overuse, particularly erythromycin, has caused significant emergence of resistant strains of bacteria such as Propionibacterium acnes. It is advised that where they are indicated (e.g. acne associated with papules and pustules), they must be used in combination with a topical agent that has anti-resistance properties (e.g. benzoyl peroxide), not as monotherapy, and limited to short-term treatment (i.e. reviewed at 6–12 weeks). It was noted that combination preparations that include a topical antibacterial have not been shown to be more effective and may be more expensive than separate products.