Topical clindamycin in the management of acne vulgaris.

Author(s): Guay DR

Affiliation(s): University of Minnesota, College of Pharmacy, Department of Experimental and Clinical Pharmacology, Weaver-Densford Hall 7-148, 308 Harvard Street SE, Minneapolis, MN, 55455, USA. guayx001@umn.edu

Publication date & source: 2007-10, Expert Opin Pharmacother., 8(15):2625-64.

Publication type: Review

A small cadre of antimicrobials are commonly used and regarded as effective and safe, as systemic and topical treatments of acne vulgaris. These include oral tetracycline, doxycycline, minocycline and topical clindamycin and erythromycin. Topical antimicrobials work via both antimicrobial and non-antimicrobial mechanisms: the former due to suppression of the growth of propionibacterial species (especially Propionibacterium acnes and P. granulosum). Clindamycin appears to be superior in efficacy compared with erythromycin and tetracycline. However, the emergence and spread of resistance among propionibacteria to both erythromycin and clindamycin calls into question their long-term viability as topical anti-acne therapies. Only through judicious use of combination topical therapies (e.g., topical retinoid, benzoyl peroxide or azelaic acid plus clindamycin or erythromycin) and the practice of effective infection control (i.e., handwashing between seeing patients in the clinic) can both clindamycin's and erythromycin's widespread utility be preserved in this disorder.