Erythromycin is used topically in the treatment of acne vulgaris. Therapy of acne vulgaris must be individualized and frequently modified depending on the types of acne lesions which predominate and the response to therapy. Topical anti-infectives, including erythromycin, are generally effective in the treatment of mild to moderate inflammatory acne. However, use of topical anti-infectives as monotherapy may lead to bacterial resistance; this resistance is associated with decreased clinical efficacy.
Topical erythromycin is particularly useful when used with benzoyl peroxide or topical retinoids. Results of clinical studies indicate that combination therapy results in a reduction in total lesion counts of 50 to 70%.
Although erythromycin was previously available for topical use in the treatment of superficial infections of the skin caused by susceptible bacteria, minor skin infections and wounds usually heal without treatment, and systemic anti-infective therapy is required for the treatment of serious or extensive skin infections such as impetigo. The currently available erythromycin ointment is intended for topical use in the treatment of inflammatory acne and not for the treatment of superficial infections of the skin. The US Food and Drug Administration (FDA) advisory panel on over-the-counter antimicrobial drugs has concluded that there is a lack of substantial evidence to demonstrate that topical anti-infectives, including topical erythromycin, are effective as skin wound anti-infectives. In addition, most clinicians state that indiscriminate use of topical erythromycin may result in the emergence of organisms resistant to the drug.
For other uses of erythromycin, see 8:12.12.04 and 52:04.04.