Antibiotic Resistance in Acne Treatment

Antibiotic Treatment for Acne Is Worsening the Worldwide Problem of Antibiotic Resistance

Antibiotic Resistance in Acne Treatment

Article Summary

Antibiotics are powerful medicines that save lives when used appropriately for bacterial infections. But because of the dangers of antibiotic resistance, and their ability to create life-long resistant strains of bacteria for the user and the world at large, they should be drugs of last resort, especially in acne treatment. And when they are used, they should be used sparingly and only for short periods of time.

Special Note: If your doctor prescribes an oral or topical antibiotic to treat your acne, do not simply accept it without question. Ask your doctor about other medications you can use instead of antibiotics. If you do use antibiotics, never use them for more than three months and always take them on time and complete the entire prescribed course, because skipping doses or stopping too soon increases the chances of developing resistant bacteria. 


Doctors frequently prescribe antibiotics to treat acne, especially severe acne. This is highly controversial because they do not tend to work better than other medications, and sometimes do not work at all. They also only offer short-term relief, when they do work at all, and have significant drawbacks that limit their usefulness. These drawbacks include many side effects, which range from mild skin irritation to permanent tooth and skin discoloration or life-threatening diarrhea, and a phenomenon called antibiotic resistance, which affects not only the individual taking the antibiotic but the world as a whole. In this article, we will discuss the problem of antibiotic resistance.

Side Effects of Oral and Topical Antibiotics for Acne

What Is Antibiotic Resistance, and Why Is It a Problem?

Treatment with antibiotics, especially over long periods of time, leads to antibiotic resistance. Antibiotic resistance means that bacteria becomes immune to the effects of antibiotics, and eventually the antibiotics can no longer kill the bacteria. Antibiotic resistance is a serious global problem because:

  • When bacteria become resistant to an antibiotic, that antibiotic becomes less effective and less able to treat the condition for which it was prescribed, and also any other bacterial condition. This applies to both the person taking the antibiotic and, eventually, the population at large.
  • Bacteria can share their genes with each other and transfer antibiotic resistance from one strain of bacteria to another.
  • Ultimately, antibiotic resistance could result in many types of bacteria becoming resistant to all antibiotic medications. This means that doctors may eventually be unable to treat bacterial infections and that people may die from even common bacterial diseases such as strep throat, as people did before antibiotics were developed.
Antibiotic Resistance in Bacteria

Antibiotic Resistance and Scientific Recommendations for Acne Treatment

Antibiotic resistance is a worrisome global threat, and over-prescription of antibiotics contributes to it.

Journal of the American Academy of Dermatology (JAAD)

A study in the Journal of the American Academy of Dermatology noted, “Despite the efficacy of antibiotics, there have been calls to limit their use in acne because of concerns for bacterial resistance.”1

In fact, several researchers have pointed out that antibiotic prescriptions for acne are a major source of concern, as acne is the most common condition for which dermatologists prescribe antibiotics. Research suggests that acne patients who are treated with antibiotics not only develop antibiotic-resistant bacteria, but are also very likely to transfer these bacteria to other people.2

Because of increasing concern about antibiotic resistance, scientists recommend that antibiotics not be used to treat acne when possible, and when needed, antibiotics should be used only for short periods of time, such as up to 3 months.1,3

Why Using Antibiotics for Longer Periods of Time Causes Problems

The reason that scientists recommend never using an antibiotic for more than three months is that longer treatment periods expose bacteria to the antibiotic for extended periods of time, giving the bacteria time to develop resistance. However, in a worrisome finding, doctors often prescribe antibiotics for considerably longer than three months, as two recent studies reported.1,4

Resistance to erythromycin and clindamycin is now a worldwide problem

Antibiotics Used to Treat Acne Cause Antibiotic Resistance

Recent research indicates that some of the antibiotics that are most frequently prescribed for acne, such as erythromycin and clindamycin, are already creating a high incidence of antibiotic resistance. Studies performed in Europe and Hong Kong have found antibiotic-resistant bacteria in approximately half or more of acne patients.5-7

Interestingly, researchers have noted similar levels of resistance both in patients treated with and without antibiotics, although those who were not treated with antibiotics have only somewhat lower levels of resistance:8 this is because resistant strains of bacteria are easily transmitted between people.9

Of all topical antibiotics, resistance to erythromycin is most common, as two scientific articles point out.3,9

Resistance to erythromycin and clindamycin is now a worldwide problem, which is made worse by the fact that resistant bacteria can be transferred among people. Oral antibiotics are also a large part of the problem because they are systemic and do not discriminate. They eliminate many groups of bacteria: this can cause many different strains of bacteria to become resistant.9

In order to reduce the risk of antibiotic resistance, scientists recommend combining antibiotics with benzoyl peroxide or topical retinoids such as tretinoin, in addition to keeping treatment duration short. These recommendations were described in a recent article for dermatologists.9

Expand to read quote from article 

American Journal of Clinical Dermatology

A 2015 article in the American Journal of Clinical Dermatology states, “In an effort to reduce resistance, avoid using topical antibiotics as maintenance therapy or monotherapy. Instead, treatment should be combined with a topical retinoid and/or benzoyl peroxide and limited to the shortest possible duration. Furthermore, simultaneous use of oral and topical antibiotics should be avoided, especially if they are chemically different.”9


As we have seen in this article, treatment with antibiotics, especially for prolonged periods of time, leads to antibiotic resistance, and this resistance is becoming a significant worldwide problem that threatens to undermine our ability to treat bacterial infections at all in the future. This could lead to people dying from even simple bacterial infections that we now routinely treat with antibiotics. We have also seen that some of the antibiotics that doctors commonly prescribe to treat acne are particularly prone to causing antibiotic resistance, and that practices such as limiting the duration of antibiotic treatment, only prescribing antibiotics for severe acne cases, and combining topical antibiotics with benzoyl peroxide or tretinoin can help reduce the development of antibiotic resistance.

Given the dangers of antibiotics, they should only be used as drugs of last resort for your acne treatment. If deemed necessary, they should be administered sparingly and for short duration.

Oral reviews Treatment (Benzoyl Peroxide - 2.5%)
Tretinoin (Retin-A, Retisol-A)

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  1. Nagler, A. R., Milam, E. C. & Orlow, S. J. The use of oral antibiotics before isotretinoin therapy in patients with acne. J. Am. Acad. Dermatol. 74, 273–279 (2016). 
  2. Sardana, K., Gupta, T., Garg, V. K. & Ghunawat, S. Antibiotic resistance to Propionobacterium acnes: worldwide scenario, diagnosis and management. Expert Rev. Anti. Infect. Ther. 13, 883–896 (2015).
  3. Strauss, J. S. et al. Guidelines of care for acne vulgaris management. J. Am. Acad. Dermatol. 56, 651–663 (2007).
  4. Lee, Y. H., Liu, G., Thiboutot, D. M., Leslie, D. L. & Kirby, J. S. A retrospective analysis of the duration of oral antibiotic therapy for the treatment of acne among adolescents: investigating practice gaps and potential cost-savings. J. Am. Acad. Dermatol. 71, 70–76 (2014).
  5. Coates, P. et al. Prevalence of antibiotic-resistant propionibacteria on the skin of acne patients: 10-year surveillance data and snapshot distribution study. Br. J. Dermatol. 146, 840–848 (2002).
  6. Ochsendorf, F. [Systemic antibiotic therapy of acne vulgaris]. J. Dtsch. Dermatol. Ges. 8 Suppl 1, S31–46 (2010).
  7. Luk, N. M. et al. Antibiotic-resistant Propionibacterium acnes among acne patients in a regional skin centre in Hong Kong. J. Eur. Acad. Dermatol. Venereol. 27, 31–36 (2013).
  8. Del Rosso, J. Q., Leyden, J. J., Thiboutot, D. & Webster, G. F. Antibiotic use in acne vulgaris and rosacea: clinical considerations and resistance issues of significance to dermatologists. Cutis 82, 5–12 (2008).
  9. Oudenhoven, M. D., Kinney, M. A., McShane, D. B., Burkhart, C. N. & Morrell, D. S. Adverse effects of acne medications: recognition and management. Am. J. Clin. Dermatol. 16, 231–242 (2015).
See More References

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