 Topical antibiotics are frequently used for mild to moderately severe acne. Oral antibiotics are indicated for moderate to severe cases of inflammatory acne, and decrease acne due to their anti-inflammatory properties and antimicrobial activity against P. acnes. Oral antibiotics are highly effective against inflammatory acne and produce faster resolution of inflammatory acne lesions than application of topical antibiotics. They are believed to work both by decreasing the number of bacteria and as an anti-inflammatory. With increasing resistance of P. acnes worldwide, they are becoming less effective. Commonly used antibiotics, either applied topically or taken orally, include clindamycin, erythromycin, metronidazole, sulfacetamide, and tetracyclines such as doxycycline and minocycline. It is recommended that oral antibiotics be stopped and topical retinoids be used once the disease has improved. Furthermore, the use of topical antibiotics alone is discouraged due to concerns surrounding antibiotic resistance, but their use is recommended in combination with topical benzoyl peroxide. Topical dapsone is not typically used as a first-line antibiotic due to its higher cost and lack of clear superiority over other antibiotics. Dapsone is not recommended for use with benzoyl peroxide due to reports of yellow-orange skin discoloration with this combination of medications.
