Topical and oral erythromycin and topical clindamycin have been well-established acne treatments for decades, but have become much less effective in the past 15 years or so due to the acquisition of resistance by P. acnes. Resistant bacteria are now induced quickly by macrolide therapy because most patients have a portion of their normal skin flora that is genetically resistant, and that subgroup expands under the selective pressure of therapy (8-11). Resistant bacteria make for acne that resists therapy and erythromycin resistant strains are typically resistant to clin-damycin and vice versa.
Resistance can be combated by the addition of BP to topical macrolide regimens. It has been clearly shown that such combination products are not only more effective than monotherapy with macrolides, but also do not permit the survival of resistant populations of P. acnes (6).
Other macrolides for example, azithromycin have been reported in small studies to be of value in acne (12), but no data is available on the effect of resistance on the utility of these drugs.
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