Antibiotics have been a mainstay of acne treatment for decades. Antibiotics help kill acne bacteria (P. acnes) and also help reduce inflammation.1-4 However, it has also long been noted that they only work for about half of the population, and produce only moderate effectiveness.5 Next, they often only work for a short period of time. Acne tends to "get used to" both oral and topical antibiotic treatments and become resistant to it.1,6 As more research comes to light, it appears antibiotics are not helping clear acne as well as they once did. Researchers theorize this may be directly related to increased bacterial resistance across the population.6
A large study conducted by the British Journal of Dermatology in 2002 studied 4274 acne patients and found that since 1991 an average of 51% of patients harbored colonies of resistant bacteria.9 Other studies have shown similar levels of antibiotic resistant acne bacteria.10 Interestingly, researchers are finding similar levels of resistance in both patients treated with antibiotics and those untreated as well, although those untreated have somewhat lower levels of resistance.11
On a microscopic level, geneticists and biologists are finding multiple possible reasons why this occurs. The first is gene mutation within a bacteria cell.2,12-14 Bacteria have also been observed banding together and producing biofilms, a coating which slows penetration of antibacterial medication.4
First, have a talk with your doctor if you are on long-term antibiotic therapy. Next, if you are prescribed antibiotics from a doctor, do not stop your course before speaking with her/him about it.
What stands out in the literature most boldly is the value of combining antibiotics with benzoyl peroxide or retinoids.2-3,15-19 When mixed with benzoyl peroxide, antibiotic therapy kills 99.9% of bacteria, resistant or not.15 Data is less available regarding the combination of retinoids such as Retin-A® or Adapalene® with antibiotic treatment. Lastly, isotretinoin (Accutane) has been shown to kill about 90% of these resistant bacteria, but still leave large colonies behind.15
I was on oral and/or topical antibiotics for a year or so altogether during high school and college. Neither therapy did anything for me. My skin was at its worst in my lifetime when I was on Clindamycin, a topical antibiotic. Antibiotics for me were like a bad joke—promising help but delivering nothing. Accutane finally cleared me up, although not entirely. When my acne returned after my Accutane course, The Regimen here at Acne.org finally got me cleared up for good."Dan Kern