Therapy for acne is often for a long period of time. Long-term antibiotic therapy is a risk factor for emergence of antibiotic resistance. Walsh et al recommended acne therapy that optimizes care while minimizing the risk for antibiotic resistance. The authors are from Heath Hospital in Cardiff, Nantes University and Independent Medical Consultancy in Oxford.

Therapy should focus around:

(1) topical benzoyl peroxide

(2) with or without topical retinoid (with restriction in pregnant women)

(3) azelaic acid as alternative to topical retinoid


Oral antibiotics should be restricted:

(1) only for moderate to severe acne

(2) limited duration (no more than 3 months)

(3) discontinue if there is no or minimal improvement

(4) should not be part of a maintenance regimen


Additional recommendations:

(1) Avoid topical antibiotics, especially as monotherapy.

(2) There may be a limited role for short-term topical antibiotics as an alternative agent in women with moderate to severe acne.

(3) Topical and oral antibiotics should never be given concurrently.

(4) Do not switch antibiotics without adequate justification.

(5) Women with moderate or severe acne may benefit from an oral antiandrogen.

(6) Oral isotretinoin may be considered for severe nodular or conglobate acne if precautions to avoid teratogenicity are taken.

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