Why Acne Does Not Respond to Antibiotics Anymore
Acne happens when hair follicles get clogged with oil, dead skin, and bacteria like Cutibacterium acnes. Doctors often prescribe antibiotics to kill these bacteria and reduce swelling. But many people find antibiotics stop working after a while. The main reason is antibiotic resistance. Bacteria change over time and learn to fight back against the drugs.
Cutibacterium acnes lives on everyone’s skin. In acne, certain types of this bacteria grow too much inside follicles and cause inflammation. Antibiotics like tetracyclines or clindamycin target these bacteria. When people use them a lot, especially for long periods, the bacteria survive and multiply. The survivors pass on their resistance to new bacteria. Overuse of broad-spectrum antibiotics makes this worse because it kills good bacteria too, letting resistant ones take over.
Studies show this resistance is now common. For example, in skin conditions like acne, over 80 percent of some lesions have bacteria that ignore drugs like penicillin or clindamycin. In acne treatment, using oral antibiotics without benzoyl peroxide raises resistance risk a lot. Benzoyl peroxide kills bacteria on the skin without helping them build resistance, so pairing it with antibiotics helps. But if treatment goes beyond three or four months without it, problems grow.
Doctors worry about this because antibiotics were once a go-to fix. Now, guidelines say use them only short-term, like a few weeks or months for bad flares. Long use harms overall antibiotic control, even for other infections. Bacteria share resistance genes easily, spreading the problem.
Other acne causes play a role too. Hormones make more oil, skin cells pile up, and swelling keeps going even if bacteria die. Antibiotics do not fix these root issues. That is why acne comes back or never clears fully.
New ideas focus on avoiding antibiotics alone. Things like retinoids clear pores, hormonal pills balance oil in women, or natural options calm swelling. Combining treatments targets all parts of acne without building resistance.
Sources
https://pmc.ncbi.nlm.nih.gov/articles/PMC12735603/
https://pmc.ncbi.nlm.nih.gov/articles/PMC12691598/
https://www.myhsteam.com/resources/antibiotics-for-hs-what-you-need-to-know
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
