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Erythromycin-resistant strains of Propionibacterium acnes, first described in the late 1970s, appear to be becoming a significant clinical problem. Researchers in Britain previously reported that 25% of patients at their large acne center have erythromycin-resistant P. acnes on their skin, and they recently showed that patients with predominantly resistant P. acnes fail to respond to oral erythromycin therapy. In an effort to ensure the continued efficacy of erythromycin in acne therapy, these researchers investigated whether benzoyl peroxide, a broad-spectrum antibacterial agent, adds to the antibacterial effect of erythromycin.
Benzoyl peroxide was tested alone and in combination with erythromycin against 40 erythromycin-sensitive and -resistant strains of Staphylococcus epidermis and proprionibacteria in vitro. In most of the bacterial strains, the combination of agents was no more effective in inhibiting the organisms than benzoyl peroxide alone.
Comment: P. acnes may have developed resistance to erythromycin, a bacteriostatic agent, as a result of the introduction of topical formulations in the late 1970s or from years of long-term systemic administration of the drug. The emergence of resistant strains poses a potentially significant problem in the management of patients with acne. This study shows that the combination of erythromycin and benzoyl peroxide is not synergistic against the majority of erythromycin-resistant propionibacteria. However, the combined use of topical benzoyl peroxide with either topical or systemic erythromycin should prevent selection for erythromycin-resistant skin bacteria and should also reduce the number of resistant strains already present on the skin. It appears rational, therefore, to avoid using unopposed erythromycin and to combine it with benzoyl peroxide.
— JS Dover
Published in Journal Watch Dermatology December 1, 1994
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