Avoid concomitant use or oral and topical antibiotics.
Co-prescription of a topical retinoid or benzyl peroxide (BPO) with oral antibiotics reduces the risk of antimicrobial resistance.
Topical antibiotics alone (e.g. clindamycin) should not be used.
Resistance to P.acnes to erythromycin is much more common than with tetracyclines so avoid unless tetracycline contra-indicated (e.g. children < 12 years or pregnancy).
Comedonal Acne - responds best to topical retinoids (e.g. Adapalene) or retinoids plus benzoxyl peroxide (BPO) (e.g. Epiduo)
Adapalene - Apply thinly OD
Epiduo - Apply thinly OD
Topical BPO + Clindamycin (Duac) - Apply thinly OD
Duration: 6-8 weeks
Reduce frequency if topical irritation occurs
Inflammatory Acne: Mild to moderate papulopustular disease may respond to topical therapy (see above). Add oral antibiotics if unresponsive to topical therapy.
Lymecycline 408mg OD
Doxycyline 100mg OD
6- 12 weeks
Severe nodulocystic disease: Start oral antibiotics (see above) and refer to dermatology.
Continue antibiotics until clinic review - if no response after 12 weeks, consider switching to alternative tetracycline or erythromycin