What Causes Acne That Does Not Respond to Antibiotics
Acne that keeps coming back even after taking antibiotics often happens because the bacteria causing it have become resistant. These bacteria, called Cutibacterium acnes or C. acnes, learn to fight off the drugs over time.[1][4] Doctors see this a lot with common antibiotics like erythromycin, clindamycin, and tetracycline.[1]
Resistance builds when antibiotics are used too long or without the right helpers. Guidelines say to limit oral antibiotics to just 3 or 4 months and pair them with topical treatments like benzoyl peroxide.[1][6] Skipping benzoyl peroxide raises the risk because it kills bacteria on the skin and stops resistance from spreading.[6] Without it, the bacteria inside pores keep growing strong.[4]
Not all acne is the same, and that can trick treatment. Bacterial acne comes from clogged pores full of oil, dead skin, and C. acnes, leading to red, painful bumps.[4] But if it is really hormonal acne or fungal acne, antibiotics alone will not fix it. Hormones make too much oil, and fungi need different care.[4]
Using antibiotics too much anywhere, not just on skin, helps resistant bacteria spread. New studies show soil bacteria already have genes that break down tetracyclines, and these can jump to acne bacteria.[5] Even short treatments can select for tougher strains if not managed right.[1]
Sometimes the acne is not just bacteria. Inflammation from oil glands stays even if bacteria die, or infections get deeper and need stronger steps.[2][3] Overwashing or wrong products make it worse by hurting the skin barrier.[4]
Newer drugs like sarecycline try to fight back by binding bacteria in special ways that resist pumps out the drug.[1] Still, the best fix starts with checking what type of acne it is and using combos wisely.
Sources
https://jcadonline.com/oral-antibiotics-in-acne-vulgaris-management/
https://pmc.ncbi.nlm.nih.gov/articles/PMC12729506/
https://ubiehealth.com/doctors-note/otc-medicine-acne-infection-11-wk1-extra1
https://naturalimageskincenter.com/common-misconceptions-about-bacterial-acne-how-to-identify-it-correctly/
https://medicine.washu.edu/news/antibiotic-resistance-circumvented-lab/
https://www.droracle.ai/articles/583200/would-a-13-year-old-female-patient-with-moderate-to-severe
