Topical Antibiotics for Acne

Pros, Cons, and When They're Considered

Since acne is, in part, caused by bacteria, topical antibiotics (meaning, those that get applied to the skin) are one way to treat acne. Topical antibiotics are typically used for mild to moderately severe inflammatory acne.

Medications like clindamycin and erythromycin are most commonly used for this purpose. Topical tetracycline is another option, but it's prescribed less often because it is known to cause skin discoloration. These come in a variety of forms, including lotions, gels, pads, and toner-like solutions.

This article covers how topical antibiotics work for acne and the possible side effects of using them. It also includes some best practices for using topical antibiotics as part of your skin care routine.

A woman putting cream on her face
 kate_sept2004 / Getty Images

Types of Topical Antibiotics for Acne

The most commonly used topical antibiotics for treating acne are erythromycin and clindamycin. They are available in solutions, lotions, gels, and saturated pads.

Clindamycin 1% solution or gel is considered the preferred treatment of the two antibiotics, in part because the risk of bacterial resistance is slightly higher with erythromycin.

Many healthcare providers avoid prescribing erythromycin all together and may only prescribe clindamycin when absolutely necessary.

What Is Bacterial Resistance?

Bacterial resistance is an increasing concern that happens when bacteria develops the ability to defeat the antibacterial drug that was designed to kill it. In terms of acne, bacterial resistance increases the risk that acne-causing bacteria will stop responding to antibiotics, making it increasingly difficult to cure acne.

Using an Additional Acne Treatment Helps Topical Antibiotics Work Better

While both erythromycin and clindamycin are effective for treating acne, they aren't usually prescribed by themselves due to the increasing risk of bacterial resistance.

Some healthcare providers also believe that topical antibiotics are becoming less effective precisely because of bacterial resistance.

Instead, combining a topical antibiotic with a second acne treatment like benzoyl peroxide is considered the safest and most effective treatment plan.

While antibiotics reduce bacteria and inflammation, they do nothing to reduce pore blockages or stop microcomedones (the tiny beginnings of a pimple under the skin) from forming.

Pairing topical antibiotics with another acne medication ensures you're treating all causes of acne, not just bacteria, so your treatment regimen will be much more effective.

Other acne medications that may be paired with topical antibiotics include:

  • Benzoyl peroxide is a likely choice. It works well with topical antibiotics and can help reduce the likelihood of developing antibiotic-resistant bacteria.
  • Topical retinoids are another option that works well with topical antibiotics. These rapidly exfoliate your skin, reducing the formation of comedones (blocked pores). 
  • Spironolactone or birth control pills aren't as commonly used, but they can be helpful in certain cases where hormonal fluctuations are contributing to acne breakouts. These can only be used by teen girls or adult women.

Combination Acne Medications Give You a Two-In-One Treatment

There are some acne treatments available that combine topical antibiotics with another acne treatment in one medication.

Combination acne medications like these aren't necessarily any more effective than using the medications separately. The benefit is they streamline your acne treatment routine. A drawback, though, is that they can be pricey compared to some other acne medications.

Some of available combination medications are:

Depending on your skin, one of these might be a good fit for you. Again, your dermatologist will help create the best treatment plan.

Some combination therapies are not readily available in pharmacies, so you may need to visit a compound pharmacy, either in-person or online, to get them. You will still need a prescription from a healthcare provider for this service.

How Topical Antibiotics Are Used

Antibiotics—oral and topical—inhibit the growth of bacteria. Propionibacteria acnes, or P. acnes, is a chief cause of acne.

This bacterium is an ordinary resident of the skin. But in those with acne, the P. acnes population grows out of control. These bacteria irritate the skin's follicles, creating inflamed papules and pustules.

Applying a topical antibiotic directly to your skin reduces the amount of the bacteria, which in turn helps control acne. Topical antibiotics also reduce inflammation, so they work best for inflamed breakouts rather than non-inflamed blemishes or blackheads.


Topical antibiotic acne treatments can sometimes cause mild skin irritation in the form of dryness and flakiness, especially when used with benzoyl peroxide or retinoids.

To help prevent this, your dermatologist may recommend using a moisturizer that contains anti-inflammatory ingredients, such as:

  • Aloe vera
  • Witch hazel
  • Bisabolol
  • Chamomile
  • Coconut oil
  • Cucumber extract
  • Green tea extract
  • St. John's wort

Always start your skincare regimen by cleaning your face, ideally with a cleanser that contains benzoyl peroxide. Next, dry your face with a clean towel, then apply your topical antibiotic acne medicine. Your moisturizer should be applied last, after you have applied your acne medicines.

Possible Side Effects

Serious side effects from topical antibiotics are very rare. Most people can use topical antibiotics without difficulty, but some people may experience some mild side effects.

Possible side effects depend on the type of medication you're using. Sometimes, the medication can burn or sting slightly when it's applied. Other side effects may include:

  • Dryness
  • Flakiness
  • Minor skin peeling
  • Mild skin irritation

Although uncommon, there have also been some reports of contact dermatitis linked to the use of topical antibiotics. That risk may be higher if you have sensitive skin, a history of allergic reactions to skin treatments, or have used topical antibiotics repeatedly.

When Are Topical Antibiotics Considered?

When considering whether a topical antibiotic is a suitable acne treatment for you, your healthcare provider will consider the location and severity of your acne, your age, and any treatment preferences you may have.

Generally, topical antibiotics are only considered for moderate to severe acne when other treatments fail to achieve the desired results. If your healthcare provider believes a topical antibiotic is necessary, they may prescribe it in combination with another acne treatment like benzoyl peroxide.


Topical clindamycin and erythromycin should not be prescribed to people who have previously had an allergic reaction to an antibiotic or a history of antibiotic sensitivity.

Topical antibiotics should also be used with caution in people who have a history of antibiotic-associated colitis, Crohn's disease, or regional enteritis, in which the small intestine is irritated or inflamed.

Some research also shows that antibiotic use may be associated with an increased risk of inflammatory bowel disease.

Clindamycin and erythromycin should not be prescribed to people who are pregnant or who could become pregnant, as the antibiotics have been linked to birth defects in clinical trials.

Furthermore, both antibiotics are known to pass into breastmilk, and should not be used by people who are breastfeeding.

Even if topical antibiotics aren't the right choice for you, your dermatologist has plenty of treatment options to help clear your skin. So don't wait to make that appointment.


Topical antibiotics like erythromycin and clindamycin are effective acne treatments that work best when paired with a second topical treatment like benzoyl peroxide or retinoids. Pairing them with another topical treatment also reduces the risk of bacterial resistance.

If you are prescribed a topical antibiotic for your acne, it's important to use it for the full course of treatment, even if your acne starts to get better after a few days. Side effects like skin dryness and flakiness are uncommon and generally mild.

Frequently Asked Questions

  • Can topical antibiotics make acne worse?

    Antibiotic use has been linked to an overgrowth of yeast; a fungal infection on the skin could make it appear that your acne has gotten worse. It's also possible that you may not see any improvement in your acne if it is caused by a

    drug-resistant strain of P. acnes.

  • How long does it take for topical clindamycin to work for acne?

    It takes anywhere from four to six weeks of clindamycin use to see a noticeable improvement in your acne.

  • Is topical clindamycin safe for long-term use?

    Topical antibiotics like clindamycin should be used for the shortest amount of time possible. Topical clindamycin is typically prescribed for a period of three to four months. Using antibiotics long-term increases the risk of bacterial resistance.

  • Are topical antibiotics for acne covered by insurance?

    Topical antibiotic acne treatments are often covered by insurance providers. Some providers may require you to first prove that the antibiotic treatment is necessary and that other acne treatments have not been successful.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Angela Palmer
Angela Palmer is a licensed esthetician specializing in acne treatment.