From the Guidelines
Topical antibiotic plus benzoyl peroxide (BPO) combinations, such as clindamycin 1% with benzoyl peroxide 5% (Benzaclin, Duac), clindamycin 1.2% with benzoyl peroxide 2.5% or 5% (Acanya, Onexton), and erythromycin 3% with benzoyl peroxide 5% (Benzamycin), are effective options for treating mild to moderate acne. These medications are typically applied once or twice daily to affected areas after gentle cleansing. Treatment duration usually ranges from 8-12 weeks, though some patients may require longer courses. These combination products are more effective than either ingredient used alone because they work through complementary mechanisms - benzoyl peroxide kills P. acnes bacteria through oxidation and has mild keratolytic effects, while antibiotics like clindamycin or erythromycin inhibit bacterial protein synthesis 1. Additionally, the benzoyl peroxide helps prevent antibiotic resistance, which is a significant concern with topical antibiotic monotherapy. Some key points to consider when using these combinations include:
- The importance of gentle cleansing before application
- Potential side effects such as dryness, redness, or peeling, especially initially
- The ability of benzoyl peroxide to bleach fabrics
- The need for sun protection as these medications may increase sun sensitivity
- The recommendation to use these combinations for the shortest possible duration to minimize the development of bacterial resistance, as suggested by guidelines 1. It is also worth noting that concomitant topical therapy with benzoyl peroxide or a retinoid should be used with systemic antibiotics and for maintenance after completion of systemic antibiotic therapy, as recommended by recent guidelines 1.
From the Research
Topical Antibiotic Plus Benzoyl Peroxide Combinations
Examples of topical antibiotic plus benzoyl peroxide combinations for treating mild to moderate acne include:
- Clindamycin 1%/benzoyl peroxide 5% (BenzaClin) gel, which has been shown to be effective in reducing inflammatory and noninflammatory lesion counts 2
- Erythromycin/benzoyl peroxide, which has been compared to clindamycin/benzoyl peroxide in clinical trials 2, 3
Efficacy and Tolerability
These combinations have been found to be effective and well-tolerated in clinical trials, with a rapid onset of action and minimal adverse events 2, 4, 5, 6
- Clindamycin/benzoyl peroxide has been shown to have a significant benefit over other treatments at Week 2, highlighting its rapid onset of action 5
- Adapalene 0.1% gel has also been compared to clindamycin 1%/benzoyl peroxide 5% gel in Asian patients with mild to moderate acne vulgaris, with both treatments showing significant efficacy and tolerability 6
Treatment Options
Other topical antiacne options include retinoids (with or without an antimicrobial agent), sulfacetamide, sulfacetamide-sulfur, and azelaic acid 4
- Combination therapy with either benzoyl peroxide or topical retinoids plus topical antibiotics (erythromycin or clindamycin) is proven most effective for moderate comedonal and mild to moderate papulopustular acne 3