Combination therapy can offer a strategy for preventing resistance to the antibiotic. Its synergistic effect can prevent more resistant bacteria, as well as other susceptible acne causing bacteria, from growing during treatment. Often when a combination topical product is used, less antibiotic is needed to prevent the growth of resistant bacteria compared to the amount needed when the antibiotic is used alone. Combination products are all effective for treating inflammatory acne and include:
1) Topical retinoid (tretinoin) plus erythromycin (Stievamycin® by Stiefel)
It should be applied to the affected areas once/day before bedtime after the skin has been thoroughly washed, rinsed and patted dry.
2) Topical benzoyl peroxide plus erythromycin (Benzamycin® by Dermik)
A thin layer should be applied to the affected areas 1 to 2 times/day after the skin has been thoroughly washed, rinsed and patted dry. This product must be refrigerated and may bleach clothing.
3) Topical benzoyl peroxide plus clindamycin (Benzaclin® by Dermik, Clindoxyl® by Stiefel in Canada)
It should be applied to skin that has been washed, rinsed and patted dry. This product does not need to be refrigerated.