From the Guidelines
Topical antibiotics such as benzoyl peroxide, clindamycin, and erythromycin are recommended for treating pimples, with benzoyl peroxide being a key component due to its ability to prevent antibiotic resistance 1. When managing acne with topical medications, multimodal therapy combining multiple mechanisms of action is recommended, including the use of topical antibiotics 1.
- The recommended topical antibiotics for acne include benzoyl peroxide, which is effective in killing acne-causing bacteria and removing excess oil and dead skin cells.
- Clindamycin and erythromycin are also effective in reducing bacteria that cause inflammation in acne.
- Combination products such as clindamycin-benzoyl peroxide gel or erythromycin-benzoyl peroxide gel are particularly effective in preventing bacterial resistance. The use of fixed-dose combination topical antibiotic with benzoyl peroxide is strongly recommended, with a moderate level of certainty of evidence 1.
- It is essential to apply these products to clean, dry skin, once or twice daily, for 6-12 weeks.
- Patients should be aware of potential side effects, such as irritation, and take steps to minimize them, such as reducing application frequency. The guidelines emphasize the importance of preventing antibiotic resistance by using concomitant benzoyl peroxide therapy 1.
- Topical retinoids are also recommended for patients with acne, and can be used in combination with topical antibiotics for enhanced efficacy 1.
- The use of systemic antibiotics should be limited to reduce the development of antibiotic resistance and other complications 1.
From the FDA Drug Label
INDICATIONS AND USAGE: Erythromycin Topical Solution is indicated for the topical treatment of acne vulgaris. INDICATIONS AND USAGE Clindamycin Phosphate Topical Solution, Clindamycin Phosphate Gel, and Clindamycin Phosphate Lotion are indicated in the treatment of acne vulgaris.
The recommended topical antibiotics for treating pimples are:
From the Research
Topical Antibiotics for Pimples
The following topical antibiotics are recommended for treating pimples:
- Clindamycin: a bacteriostatic antibiotic that is effective against Propionibacterium acnes (P. acnes) and has anti-inflammatory properties 4, 5
- Erythromycin: a bacteriostatic antibiotic that is effective against P. acnes and has anti-inflammatory properties 4, 5
- Benzoyl peroxide: a non-antibiotic antibacterial agent that is bactericidal against P. acnes and has the advantage of no reported resistance 4
Combination Therapies
Combination therapies that include topical antibiotics and other agents are also effective in treating pimples:
- Clindamycin/benzoyl peroxide gel: a combination formulation that is effective in reducing the emergence of resistant strains of P. acnes and provides rapid onset of action 6, 7
- Erythromycin/benzoyl peroxide: a combination therapy that is effective in reducing the development of antibacterial resistance in P. acnes 4
- Clindamycin/tretinoin: a combination therapy that is effective in treating acne vulgaris, but may not provide additional benefits over clindamycin/benzoyl peroxide 6
Selection of Topical Antibiotics
The selection of a topical antibiotic should be tailored to the individual patient's skin characteristics and acne type 4. Topical antibiotics should generally not be used for extended periods beyond 3 months, and should not be combined with systemic antibacterial therapy for acne 4, 8