Topical Antibiotics

The Basics

There are many topical antibiotics available for the treatment of acne.  Topical antibiotics are frequently a part of treatment regimens for all types of acne symptoms (Acne Types: 1-4).  Most of the antibiotics are well tolerated, are minimally irritating and have few other side effects.  Because you apply the treatment directly to the skin, you avoid the most common problem with oral antibiotic use, gastro-intestinal problems (e.g. upset stomach).  For mild to moderate acne, topical antibiotics can provide some relatively quick improvement in acne sypmtoms.

Like oral antibiotics, topical antibiotics treat acne by inhibiting the growth of bacteria in the skin that triggers the inflammation associated with pimples.  Unfortunately, topical antibiotics have two major drawbacks.  First, the majority of people report that most of these treatments lose effectiveness over time, eventually to the point where it makes no real difference.  Second, most topical antibiotics do not penetrate deeply into the skin.  As a result, the use of topical antibiotics alone is generally insufficient for patients suffering from inflammatory acne (Acne Types: 3-4).  For an overview of the most widely used antibiotic families, read Overview: The Major Antibiotic Families

Medication Ratings

The scores listed by each medication represent their composite score on a Scale of 1 (worst) to 5 (best). The composite score is calculated by combining individual scores from several categories: Antibiotic Susceptibility (Scientific Reports), Effectiveness (User Reported) and Side Effects (User Reported). For more information, click on the rating image to view the ranking breakdown for that medication.

Clindamycin (Clindoxyl)

Clindamycin Composite Score

Type of Treatment: Rx MedicationAntibiotic (Oral and Topical) – Lincosamide Family
Official Name: Clindamycin
Popular Brand Names: Cleocin, Dalacin, Duac (Clindamycin and Benzoyl Peroxide) and Zindaclin.
Related Medications: Lincomycin, Novobiocin, Erythromycin, Azithromycin, Clarithromycin.

Clindamycin is a lincosamide family antibiotic that is a popular topical acne treatment. It commonly comes packaged alone or mixed with benzoyl peroxide.  This antibiotic generally has a mild side effect profile when used topically.  Clindamycin can be very effective, but clindamycin resistant bacteria are a growing problem in many counries.

Dapsone (Aczone)

Dapsone (Aczone) Composite Score

Type of Treatment: Rx MedicationAntibiotic (Oral) Sulfonamide Family
Official Name: Dapsone
Popular Brand Names: Aczone.
Related Medications: Co-trimoxazole, sulfamethoxazole, sulfacetamide, sulfadiazine, mafenide.

One of the original oral antibiotics used to treat cystic acne, dapsone fell out of favor after the development of isotretinoin (Accutane).  Recently, dapsone has been reformulated and FDA approved as a topical gel for the treatment of acne.  The efficacy of topical dapsone is still being established.  Dapsone has both antibacterial properties, and anti-inflammatory properties, which may be helpful in the treatment of inflammatory acne.

Erythromycin (Aknemycin)

Erythromycin Composite Score

Type of Treatment: Rx MedicationAntibiotic (Oral and Topical) – Macrolide Family
Official Name: Erythromycin
Popular Brand Names: Aknemycin, E-Mycin, Benzamycin (erythromycin and Benzoyl Peroxide), Stiemycin and Eryacne.
Related Medications: Azithromycin, Clarithromycin, Roxithromycin, Tylosin, Clindamycin.

Like clindamycin, erythromycin is a commonly prescribed topical treatment for acne, and often comes packaged alone or with benzoyl peroxide.  Unfortunately, the majority of acne associated P. acnes bacteria in the United States and Europe are resistant to erythromycin.

Fusidic Acid (Fucidin)

Fusidic Acid Composite Score

Type of Treatment: Rx MedicationAntibiotic (Oral and Topical) – Fusidic Acid Family
Official Name: Fusidic Acid
Popular Brand Names: Foban, Fucidin, Stanicid and Fusimax.

Fusidic acid is a topical antibiotic that inhibits bacterial growth by preventing bacterial protein synthesis.  Originally developed and marketed in the 60’s, fusidic has garnered renewed interest because of the emergence of widespread bacterial resistance to many common antibiotics.  While fusidic acid is available in many countries, it is not approved for sale in the United States.  Based on user reports, fusidic acid has a medium efficacy profile in the treatment of acne.   It can be combined with many other medications, but it is not recommended for long term use.

Mafenide (Sulfamylon)

Mafenide (Sulfamylon) Molecule

Type of Treatment: Rx MedicationAntibiotic (Topical)Sulfa Family.
Official Name: Mafenide.
Popular Brand Names: Sulfamylon

Mafenide is commonly used in the prophylactic treatment of severe burns, much like silver sulfadiazine.  Mafenide is a sulfonamide family antibiotic.  It’s utility in the treatment of acne is untested.

Metronidazole (MetroGel)

Metronidazole moleculeType of Treatment: Rx MedicationAntibiotic (Oral and Topical) – Nitroimidazole Family
Official Name: Metronidazole
Popular Brand Names: Anabact, Flagyl, Metrogel and Rozex.
Related Medications: Tinidazole.

Metronidazole (Metrogel) is commonly used as a treatment for Rosacea and other skin diseases.  Metronidazole is also occasionally prescribed for the treatment of acne vulgaris.  However, metronidazole tends to be an ineffective acne treatment.  Propionibacterium acnes, the bacteria most commonly associated with acne vulgaris, is naturally resistant to metronidazole.  .

Mupirocin (Bactroban)

Mupirocin (Bactroban) Composite Score

Type of Treatment: Rx MedicationAntibiotic (Topical) Pseudomonic Acid Family
Official Name: Mupirocin
Popular Brand Names: Bactroban, Centany, Dermoban, Micoban.

Mupirocin is a well reviewed topical acne treatment that is composed of a mixture of pseudomonic acids, which were originally isolated from a bacteria, Pseudomonas fluorescens.  It acts by inhibiting protein and RNA synthesis in susceptible bacteria.  Many patients using mupirocin for the treatment of acne report favorable results during initial use, but notice a relatively rapid decrease in efficacy.  This may be due to the fact that resistance to this class of antibiotic is relatively easily aquired by the target bacteria. Most strains Propionibacterium acnes are naturally resistant to mupirocin.

Nadifloxacin (Nadixa)

Nadifloxacin (Nadixin) Composite Score

Type of Treatment: Rx MedicationAntibiotic (Topical) – Quinolone Family
Official Name: Nadifloxacin.
Popular Brand Names: Acuatim, Nadixa, Nadixin, Nadiflox and Nadoxin.
Related Medications: Ciprofloxacin, Moxifloxacin, Ofloxacin, Levofloxacin, Norfloxacin, Sparfloxacin, Gatifloxacin.

Nadifloxacin is topical fluoroquinolone antibiotic that has been recently studied for its effectiveness in the treatment of acne.  Nadifloxacin, a relative of the more common fluoroquinolone ciprofloxacin, is a broad spectrum antibiotic.  Recent research has shown that nadifloxacin may be more effective at penetrating deep into the tissue than other topical antibiotics, making it a useful treatment for nodular and cystic acne.  As a relatively new treatment for acne, nadifloxacin is not commonly prescribed by dermatologists and is not widely available.

Neomycin, Bacitracin and Polymyxin B (Neosporin)

Neomycin moleculeType of Treatment: OTC MedicationAntibiotic (Topical) – Aminoglycoside and Polypeptide Families
Official Name: Neomycin, Bacitracin and Polymixin B
Popular Brand Names: Neosporin, Triple Antibiotic Gel.

Neomycin, bacitracin and polymixin B are commonly combined and sold as a topical antibacterial gel.  The most common form of this medication is the popular OTC medication – Neosporin.  Neosporin is commonly used to prevent infections in minor wounds and to accelerate healing.  Neosporin is also occasionally used by acne patients as a spot treatment for pimples.  However, there is little evidence that neosporin is an effective acne treatment (although it may be helpful to accelerate healing after popping a pimple).

Retapamulin (Altabax)

Retapamulin Composite Score

Type of Treatment: Rx MedicationAntibiotic (Topical)Pleuromutilin Family.
Official Name: Retapamulin
Popular Brand Names: Altabax and Altargo.

Retapamulin is a recently approved member of the pleuromutilin family of antibiotics, a newly developed class of antibiotics.  Like fusidic acid, retapamulin inhibits bacterial growth by preventing bacterial protein synthesis.  Preliminary research has shown that Retapamulin is effective against a number of skin infections, including acne.  It may be especially helpful in treating acne that fails to respond to more traditional antibiotic therapies.

Silver Sulfadiazine (Silvadene)

Silver Sulfadiazine (Silvadene) Molecule

Type of Treatment: Rx MedicationAntibiotic (Topical)Sulfa Family.
Official Name: Silver Sulfadiazine
Popular Brand Names: Flamazine, Silvadene, Thermazene.

Silver sulfadiazine is most commonly prescribed as a prophylactic antibiotic treatment to prevent infection in burn victims.  It is also occasionally used in the treatment of acne.  Silver sulfadiazine is a sulfa family antibiotic.  It is poorly soluble and does not penetrate the skin well, making it poorly suited for use by those with nodular and cystic acne.

Sulfacetamide (Clenia)

Sulfacetamide (Clenia) Composite Score

Type of Treatment: Rx MedicationAntibiotic (Topical) – Sulfa Family
Official Name: Sulfacetamide.
Popular Brand Names: Bleph, Cetamide, Clenia and Klaron.
Related Medications: Sulfamethoxazole, Co-Trimoxazole, Silver Sulfadiazine, Dapsone, Sulfamylon.

Sulfacetamide is a sulfonamide family antibiotic that has shown good efficacy in the treatment of acne.  Sulfacetamide commonly comes as a 10% solution packaged alone, or in combination with a 5% sulfur solution.  Sulfur was one of the original treatmentsfor skin infections, with its use dating back to the ancient romans.  Both sulfacetamide and sulfur have antibacterial properties, and sulfur itself is a keratolytic agent, which can help clear plugged pores.

Tetracycline (Topicycline)

Tetracycline (Sumycin) Composite Score

Type of Treatment: Rx MedicationAntibiotic (Topical and Oral) – Tetracycline Family
Official Name: Tetracycline.
Popular Brand Names: Sumycin, Tetracap, Topicycline, Hostacyclin, Lupitetra.
Related Medications: Doxycycline, Minocycline, Lymecycline, Oxytetracycline, (Tigecycline).

Topical tetracycline is available for the treatment of acne, but is rarely prescribed due to its poor efficacy and side effects profile.

Related Articles from The Science of Acne

What is Acne Vulgaris?
What Causes Acne?
Prescription Medications and Acne Vulgaris
Naturopathic Medicine and Acne Vulgaris
Light and Laser Therapies and Acne Vulgaris
Over the Counter Medications (OTC) and Acne Vulgaris

References and Sources


PDR Staff Writers. 2011. 2011 Physicians’ Desk Reference (PDR)
Habif. 2009. Clinical Dermatology
Goodheart. 2006. Acne For Dummies

Online Resources

Antibiotics @ Wikipedia
Acne Vulgaris @ Wikipedia
Acne Vulgaris @ eMedicine
Topical Antibiotics @
Acne Treatment Reviews @

Scientific Research Articles

Gamble, et al. 2012. Topical Antimicrobial Treatment of Acne Vulgaris: An Evidence-Based Review.
Zeichner, et al. 2012. Optimizing topical combination therapy for the treatment of acne vulgaris.
Mahmoudi, et al. 2011. Comparison of efficacy of Azithromycin vs. Clindamycin and Erythromycin in the treatment of mild to moderate acne vulgaris.
Williams, et al. 2011. Acne vulgaris.
Toyoda, et al. 1998. An overview of topical antibiotics for acne treatment.
Imahiyerobo-Ip, et al. 2011. Changing the topography of acne with topical medications.
Davis, et al. 2010. A review of acne in ethnic skin: Pathogenesis, clinical manifestations, and management strategies.
Sathish, et al. 2011. Acne and Its Treatment Options – A Review.
Ingram, et al. 2009. Management of acne vulgaris: an evidence-based update.
Schroeder, et al. 2012. Medications used for Acne vulgaris: Practice trends and the use of topical combination products.
Barratt, et al. 2008. Outcome measures in acne vulgaris: systematic review.
Patel, et al. 2010.
The development of antimicrobial resistance due to the antibiotic treatment of acne vulgaris: a review.
Lee, et al. 2010.  Effectiveness of conventional, low-dose and intermittent oral isotretinoin in the treatment of acne: A randomized, controlled comparative study.
Strauss, et al. 2007.  Guidelines of care for acne vulgaris management.