The effect of zinc and erythromycin on the growth of erythromycin-resistant and erythromycin-sensitive isolates of Propionibacterium acnes: an in-vitro study

Abstract

The effect of zinc and erythromycin on cultures inoculated with mixtures of different ratios of erythromycin sensitive (ES) and resistant (ER) Propionibacterium acnes cells was studied in vitro. Propionibacterium acnes ES outgrew P. acnes ER in the absence of erythromycin and zinc. At low levels of erythromycin ES outgrew ER, whilst the addition of 600 pg/ml zinc further reduced the growth of ER compared to ES. Growth of ER and ES were similar at levels of erythromycin near the minimum inhibitory concentration (MIC) of ES cells. Concentrations above the MIC for ES cells inhibited ES but not ER cells. At the higher concentrations of erythromycin, the addition of 96 ng/ml zinc delayed the growth of ER cells, whilst the addition of 300 micrograms/ml zinc prevented the growth of ER cells. The combination of erythromycin and zinc, at appropriate concentrations, inhibits both ES and ER.

Bacterial resistance in French acne patients

“…The in vitro addition of increasing doses of zinc salt (15-30 mg/l) reduces the number of resistant strains of P. acnes. 24 Concomitant application of topical erythromycin and benzoyl peroxide appears to have the same ability as zinc to inhibit the growth of pre-existing erythromycin-resistant P. acnes and to prevent the selection of resistant strains which occurs when the antibiotic is used alone. 25 This combination definitely proved effective in preventing the development of antibiotic resistance in acne patients and conferred significant clinical improvement to patients who have already developed antibiotic resistance.…”

Multicenter Randomized Comparative Double-Blind Controlled Clinical Trial of the Safety and Efficacy of Zinc Gluconate versus Minocycline Hydrochloride in the Treatment of Inflammatory Acne vulgaris

“…Holland et al [19] , using zinc and erythromycin, showed in vitro that the growth of erythromycin-resistant strains of P. acnes was inhibited by the addition of 300 µg/ml of zinc to 1,000 µg/ml of erythromycin. In vivo, Habbema et al [20], Schachner et al [21]and Feucht et al [22]showed that the combination of zinc and erythromycin was more effective than erythromycin alone on the course of inflammatory acne lesions.…”

A randomized, single‐blind comparison of topical clindamycin + benzoyl peroxide (Duac®) and erythromycin + zinc acetate (Zineryt®) in the treatment of mild to moderate facial acne vulgaris

“…11 In vitro , the combination of erythromycin and zinc at appropriate concentrations inhibits both erythromycin-sensitive and erythromycinresistant propionibacteria. 12 However, Bojar et al . 13 found that while a commercial formulation of erythromycin/ zinc (4% erythromycin) was effective against erythromycinresistant propionibacteria in acne patients, 4% erythromycin alone eradicated the resistant propionibacteria.…”