The Best Antibiotic for Acne is Non-Prescription
The accident that saved my skin.
My skincare routine used to be a terrifying amalgam of creams, most of which were acquired by a nasty (but skillful) shoplifting addiction. I needed only around 20% of these items, which is why I would place a product in the middle of my dorm hallway every week when no one was looking. Everyone knew it was me and so the day after I would nearly trip over whatever product had been moved in front of my door.
Since coming back from art school—and ceasing my activities—my routine was pared down to washing my face with water, putting on a retinoid, and ending off with a light moisturizer. However! One day my routine was interrupted… unbeknownst to me, I had put Neosporin (instead of adapalene) on my lovely pores. What came the next morning was nothing short of a miracle.
Neosporin is a mixture of three antibiotics (Neomycin, Polymyxin, and Bacitracin) in a petrolatum carrier. It also happens to be highly efficient in combating a great annoyance: C. acnes bacteria (formerly known as P. acnes). Despite this, I've seen a lot of claims to the contrary, most stemming from this article. The only thing resembling a claim here is a feeble, “Neosporin’s three active ingredients... may not work against acne.” This is only about 2/3rds of a truth. Neomycin and Polymyxin are totally useless as anti-acne drugs, they’ve got that. But while they consider Bacitracin as potentially effective, they dismiss it for, uhhh undisclosed reasons? I guess?
The academic literature on this topic presents a very different story. Bacitracin is incredibly effective at suppressing C. acnes, “The susceptibility to triple antibiotic ointment (neomycin/bacitracin/polymyxin) and bacitracin alone was 100%.” (Ma et al., 2016) This study examined the effects of bacitracin vs. prescribed agents Of the samples collected from the population, over half had received prior antibiotic treatment. There was 0% bacterial resistance to Bacitracin observed at a breakpoint of ≤ 2 IU/ml (this is very small) as recommended by the Clinical and Laboratory Standards Institute (CLSI). Breakpoint refers to the minimum "concentration of an antibiotic at which bacterial growth is completely inhibited" (Kowalska-Krochmal & Dudek-Wicher, 2021). Rates of resistance to Clindamycin and Erythromycin were 33.4% and 49.3% respectively.
There are two maybe valid concerns about its use, 1-6% of people who use Neosporin may have a skin allergy to it, this however can be easily tested prior to use, or you can just use straight bacitracin. The other concern is a possible depletion of skinflora. Skinflora refers to the environment of bacteria on your skin, all of which keep each other in check to prevent infection. Unlike the gut microbiome, the ecosystem of the skin seems very resilient to antibiotic-induced dysbiosis. This is why people who undergo antibiotic treatment on their skin don't have long lasting deleterious effects. The only reports observing adverse effects have come with numerous caveats. The patients in these studies are often either taking them orally or are among a number of case reports which doctors erroneously prescribe strong topical antibiotics for open wounds (leading to systemic absorption and gut dysbiosis) or for… eczema???
With that spiel I hope more people become open to the usage of Neosporin/Bacitracin for Acne. Proof of concept on self:
![r/SkincareAddiction - [Research] [Effortpost] Neosporin/Bacitracin is an effective antibiotic for Acne](https://substackcdn.com/image/fetch/$s_!Ua5a!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F9f18203f-1b33-4e1c-9257-deac9e8bde8c_993x720.png "r/SkincareAddiction - [Research] [Effortpost] Neosporin/Bacitracin is an effective antibiotic for Acne")
TL;DR: Bacitracin Suppresses the bacteria responsible for acne at a rate of 100% in a petri dish. There was zero bacterial resistance observed. Concerns about skinflora and skin allergy are unfounded.
Bibliography
Sullivan, D., & Zambon, V. (2020, April 27). Neosporin for acne: Does it work and alternatives. www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/neosporin-for-acne
Ma, Y., Zhang, N., Wu, S., Huang, H., & Cao, Y. (2016). Antimicrobial activity of topical agents against Propionibacterium acnes: an in vitro study of clinical isolates from a hospital in Shanghai, China. Frontiers of Medicine, 10(4), 517–521. https://doi.org/10.1007/s11684-016-0480-9
Kowalska-Krochmal, B., & Dudek-Wicher, R. (2021). The minimum inhibitory concentration of antibiotics: methods, interpretation, clinical relevance. Pathogens, 10(2), 165. https://doi.org/10.3390/pathogens10020165
Interesting! The late psychologist Seth Roberts was a staunch advocate of self-experimentation. He also had acne and did experiments on himself. He found that his acne didn't respond to treatment with an oral antibiotic (tetracycline), but it improved with benzoyl peroxide cream. He also found that multi-B vitamin supplements helped, whereas pizza and Diet Pepsi made it worse. https://freakonomics.com/2005/09/seth-roberts-on-acne-guest-blog-pt-iv/
Have you considered adding topical ivermectin (Sklice) to your regimen? I’ve long suspected that Demodex mites actually cause acne, and adding topical ivermecti—used to eliminate head lice—can kill off the active growth of these mites as well. The antibiotics address the actual infection, and together with the topical ivermectin will eliminate most if not all of the problems associated with acne. It has worked for me!