What's new in antibiotics in the management of acne?

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit with a multifactorial pathogenesis. Topical and oral antibiotics are a mainstay treatment for inflammatory acne lesions and are widely utilized for all levels of disease severity. Over the past forty years, a gradual increase in antibacterial-resistant strains of Propionibacterium acnes has changed the way practitioners use antibiotics to manage acne. Updated recommendations call for avoiding antibiotic monotherapy and prescribing it in combination with benzoyl peroxide or retinoids. In addition to reducing the risk of developing bacterial resistance, antibiotics prescribed in combination formulations with benzoyl peroxide or retinoids are more efficacious than monotherapy, provide fast therapeutic results, and are associated with greater patient adherence due to the simplification of treatment regimens. Newer management strategies include limiting antibiotic use to the initial 3-6 months of treatment and then switching to topical retinoids for maintenance therapy.