The extinction of topical erythromycin therapy for acne vulgaris and concern for the future of topical clindamycin

Abstract

Objective: This study aims to evaluate changes in topical antibiotic prescribing trends for acne.Methods: We retrospectively reviewed the National Ambulatory Medical Care Survey data from 1993 to 2012 for all visits in which acne vulgaris was the primary diagnosis.Results: Acne vulgaris represented an estimated 94.5 million (92.3, 96.8) visits during the 20-year study period. Bivariate analysis showed that over time erythromycin use declined (p < 0.001) and clindamycin use rose (p = 0.10). Multivariate analysis showed that the likelihood of erythromycin use declined to near zero (p < 0.001), whereas clindamycin utilization increased (p < 0.05). PubMed searches of “erythromycin AND resistance” and “clindamycin AND resistance” demonstrated increasing publication frequency by year, fit with sigmoidal functions (erythromycin: R2 = 0.93 and clindamycin: R2 = 0.94). Yearly publications consistently exceeded 100 papers for erythromycin and clindamycin resistance in 1983 and 2003, respectively, roughly corresponding to the interval between reports of their utility in acne.Conclusions: Our findings suggest topical erythromycin use for acne has essentially ceased. By contrast, clindamycin use is increasing. Current recommendations discourage topical antibiotic monotherapy in favor of combination therapy with benzoyl peroxide and topical retinoids. Our group’s previous work demonstrated that this trend is indeed occurring.