Erythromycin-Benzoyl Peroxide Usage in Acne Vulgaris - An Overview

Drug Overview

Benzoyl peroxide helps remove excess oils and debris from the skin and helps eliminate germs that cause acne. It has mild drying action and antibacterial qualities. This effect is complemented by the topical antibiotic Erythromycin, which stops bacterial development on the skin. They work well together as a combination drug applied topically to treat acne. There may be other possible uses for this medication outside of treating acne. However, that has to be discussed with the healthcare worker. To ensure a safe and informed application of this topical combination, patients should follow the indicated usage guidelines and consult with healthcare practitioners for any unlisted purposes. On October 26, 1984, the United States Food and Drug Administration (US-FDA) approved using Erythromycin and Benzoyl peroxide.

Drug Groups

Erythromycin and Benzoyl peroxide belong to the category of topical antibiotics.

Available Doses and Dosage Forms:

Erythromycin and Benzoyl peroxide combined as topical gel should be applied twice daily, in the morning and the evening, or as a physician prescribes. The face should be carefully cleaned, rinsed with warm water, and gently patted dry before applying to the affected areas.

For Patients:

What Is Acne?

The most common type of acne, known as acne vulgaris, is defined by a combination of inflammatory and non-inflammatory lesions on the skin. Acne mostly affects the face but can also affect the chest, neck, back, and sometimes other body sections. The pilosebaceous unit, which includes the oil gland and hair follicle, is the center of each lesion. Acne spots of different kinds frequently coexist. They can appear as nodules, non-inflammatory comedones (blackheads and whiteheads), inflammatory papules (tiny, sensitive red lumps), pustules (white or yellow "squeezable" spots), and pseudocysts (cyst-like fluctuant swellings). The disease may affect the face and other parts of the body, leading to a wide range of skin symptoms.

How Does Erythromycin-Benzoyl Peroxide Work?

For the treatment of acne, Erythromycin and Benzoyl peroxide are combined. These drugs fall under the category of topical antibiotics. Their combined effect includes getting rid of the acne-causing microorganisms. It functions by eliminating the bacteria responsible for acne and maintaining the cleanliness of the skin's pores (microscopic openings in the skin).

What Are the Things to Inform the Doctor About Before Taking the Erythromycin-Benzoyl Peroxide?

• Before starting the drug, people should tell their doctor and pharmacist about any allergies, especially if they are allergic to Benzoyl peroxide, Erythromycin, or any other medication.

• It is also important to share a comprehensive list of all current prescription and over-the-counter drugs, vitamins, supplements, and herbal remedies. Other topical acne medicines may require close monitoring or dosage modifications, so more care should be taken.

• It is recommended that people inform their healthcare provider of any relevant medical issues. It is important to notify the doctor as soon as possible if individuals are planning a pregnancy, are already pregnant, or are breastfeeding. Consultation with the healthcare practitioner as soon as possible is advised if Erythromycin and Benzoyl peroxide are used during pregnancy.

• Since Benzoyl peroxide and Erythromycin might make skin more sensitive to sunlight, care should be taken in the sun while receiving treatment. Preventative steps, including wearing protective clothes, sunglasses, and sunscreen, are also advisable.

• People should speak with their pharmacist or healthcare professional for advice on the right moisturizer to keep their skin feeling smooth during treatment.

• It is important to remember that the combination of Erythromycin and Benzoyl peroxide is combustible and that people should not combine, apply, or keep it next to an open flame.

How Is Erythromycin-Benzoyl Peroxide Administered?

The combination of Erythromycin and Benzoyl peroxide gel is intended for topical use and effectively treats skin disorders. The gel should normally be applied twice daily, in the morning and the evening. Consistency is essential, so try to apply it at roughly the same times each day. Treatment efficacy is increased when the recommended regimen is followed.

• Patients are advised to follow the instructions on their prescription label carefully and to ask their pharmacist or healthcare professional for clarification on any un apparent instructions. It is essential to follow the recommended dosage and frequency exactly. The suggested frequency of usage for the gel should be within the limit, and the amount prescribed should be increased.

• Patients should be informed that it can take some time to experience the medication's full therapeutic benefits. A few weeks or more may pass before any visible progress is made. Even if there are no side effects immediately, it is crucial to keep taking the prescription as prescribed, regardless of any initial challenges.

• The steps to apply the ointment are mentioned below:

  • After using a light soapless cleaner to wipe affected areas, gently pat dry using a fresh towel.

  • If the drug is packaged in tiny pouches, open the pouch without using the teeth by pulling off the top at the notched tab.

  • Gently press the contents of the pouch onto the palm to reveal a white and transparent gel.

  • If the drug comes in a big container, use the finger to scoop out a pea-sized amount.

  • Using the fingertip, blend the gels in five to ten circular strokes.

  • Using the fingertips, evenly distribute a small gel layer over the affected region. Use caution to prevent contact with the mouth, nose, eyes, or other body openings. Warm water should be washed if the eyes come in contact with the ointment.

What Are the Side Effects of Erythromycin-Benzoyl Peroxide?

Erythromycin plus Benzoyl peroxide may have certain negative effects. Individuals must notify their doctor immediately if there are any uncomfortable or persistent symptoms. Common side effects include dry skin, peeling, itching, stinging, burning, tingling, or redness. These symptoms are usually mild and transient. Other common adverse effects include changes in skin texture, such as oiliness, tenderness, or discoloration. While most complications are manageable, some might need to see a doctor immediately. These include the following:

• Severe diarrhea.

• Severe stomach discomfort or cramps.

• Changes in skin or nail conditions that suggest a fungal infection.

• Face or nasal puffiness.

• Eye irritation and swelling.

• Blood or mucus in the stool.

• Hives.

Guidelines for the Safe Administration of Topical Gel of Benzoyl Peroxide and Erythromycin

• Since they may worsen these symptoms, Benzoyl peroxide and Erythromycin topical gel should not be applied to windburned, sunburned, dry, chapped, or irritated skin. They should also be kept out of contact with cuts and eczema-affected areas.

• Avoid using products that irritate the skin, like strong cleansers, shampoos, hair coloring, hair removers, and products containing spices, astringents, alcohol, or lime.

• Diarrhea may occur after taking antibiotics, suggesting the possibility of a new infection. If a person has bloody or watery diarrhea, stop taking the drug and see a doctor. Avoid using anti-diarrhea medication without first consulting a doctor.

• Erythromycin and Benzoyl peroxide can make the skin more sensitive to the sun, limiting time spent in the sun or tanning beds. When going outside, dress safely and apply sunscreen with a sun protection factor (SPF) of 30 or higher. Sunscreen containing PABA (para amino benzoic acid) should be avoided.

• Benzoyl peroxide and Erythromycin topical gel medication should not be used on hair, clothing, colored linens, or towels, as Benzoyl peroxide can bleach them.

Dietary Considerations:

People should stick to their regular diet unless their doctor instructs them otherwise.

Missed Dose:

The patient should apply the missed Erythromycin and Benzoyl peroxide dose as soon as they recall. On the other hand, it is best to avoid taking the missed dose and continue with the regular dosing plan if the next dose is almost due. Applying two doses to make up for a missed one should be avoided, as this could raise the possibility of negative side effects.

Overdose:

Usually, overdosing on topical Erythromycin and Benzoyl peroxide is not regarded as harmful. However, immediate medical attention is recommended in the event of accidental consumption.

Storage:

Keep the ointment of Erythromycin and Benzoyl peroxide out of children's reach and in a sealed container. Do not freeze the ointment; instead, keep it refrigerated. If the user needs to remember to refrigerate the gel for a day, they may recall doing so and continue using it. The ointment should be kept out of the bathroom and stored at room temperature, away from extreme heat and moisture sources. After three months, the medication should be disposed of.

It is important to dispose of unneeded medications in a way that protects kids, pets, and other people to avoid accidental ingestion. It is not advised to flush the medication down the toilet. Instead, using a medication take-back program is the preferred way to get rid of medications. For information on available take-back initiatives in their neighborhood, the person can speak with their pharmacist or contact the local government's recycling or garbage department.

For Doctors:

Indication

Acne vulgaris is treated topically with Erythromycin-Benzoyl peroxide.

Contraindication:

People with a history of known hypersensitivity to any ingredients in Erythromycin-Benzoyl peroxide should not use it.

Dose

After the affected areas have been thoroughly cleaned, rinsed with warm water, and gently patted dry, the topical gel of Erythromycin and Benzoyl peroxide should be administered twice daily, in the morning and the evening, or as prescribed by a physician.

What Are the Pharmacological Aspects of Erythromycin-Benzoyl Peroxide?

Description

• Molecular Formula:

  • Erythromycin - C37H67NO13.

  • Benzoyl Peroxide - C14H10O4.

• Molecular Weight:

  • Erythromycin - 733.94.

  • Benzoyl Peroxide - 242.23.

• Appearance: Crystalline solid (white to off-white).

• Solubility:

  • Erythromycin - Soluble in water and alcohol (25 degrees Celsius).

  • Benzoyl Peroxide - Soluble in acetone, chloroform, and ether and very slightly soluble in water and alcohol.

Mechanism of Action

Erythromycin's antimicrobial qualities contribute to its effectiveness in treating acne vulgaris, although the exact process is unknown. Erythromycin is an antibiotic belonging to the macrolide class, which prevents Propionibacterium acne from growing, as it is thought to be a major cause of acne lesions. On the other hand, Benzoyl peroxide uses two different strategies to treat acne. Firstly, its keratolytic and desquamative properties help break down keratin and encourage skin exfoliation, which helps to avoid pore blockages. Secondly, the skin absorbs Benzoyl peroxide and transforms it into benzoic acid. This metabolite probably increases Benzoyl peroxide's antibacterial activity and has minor anti-inflammatory properties, increasing the drug's therapeutic efficacy in treating acne.

Pharmacokinetics - Benzoyl peroxide is absorbed through the skin and transforms into benzoic acid. The systemic absorption of Erythromycin was evaluated in single-dose pharmacokinetic research, including 16 adult acne patients who applied one or three units of the drug. Notably, Erythromycin was mostly undetectable in plasma, with a lower limit of quantification defined at 2 ng/ml (nanogram per milliliter). Therefore, It was significant that one patient in the group receiving one unit of application had a plasma containing measurable amounts of Erythromycin. This finding highlights the significance of examining topical therapy’s systemic absorption as it offers important information about its pharmacokinetic characteristics and possible interindividual variability.

Pharmacodynamics - The exact methods by which Benzoyl peroxide and Erythromycin lessen acne vulgaris lesions are still unknown.

Microbiology

Erythromycin binds reversibly to the 50 S ribosomal subunits in sensitive species to suppress protein synthesis. This binding hinders polypeptide synthesis by preventing aminoacyl transfer-RNA (ribonucleic acid) from translocating. Research conducted in vitro has indicated that Erythromycin exhibits antagonistic properties with specific antibiotics, including Clindamycin, Lincomycin, and Chloramphenicol.

Benzoyl peroxide is an antibacterial agent that is efficacious towards Propionibacterium acnes, an anaerobic bacterium found in comedones (dark bumps on the skin) and sebaceous follicles. Active oxygen released by Benzoyl peroxide is thought to have antibacterial properties, which helps explain why it works so well to treat acne.

Toxicity (Carcinogenesis, Mutagenesis, and Infertility)

According to data from a study involving mice susceptible to cancer, Benzoyl peroxide may act as a tumor promoter. However, the clinical importance of this observation has yet to be discovered. On the other hand, the carcinogenicity, mutagenic potential, and reproductive consequences of topical Erythromycin have not been evaluated in any animal research. However, neither Erythromycin ethyl succinate nor Erythromycin base showed any signs of tumorigenicity in two years of oral tests conducted in rats. Rats exposed to Erythromycin (base) at doses up to 0.25 percent of the food also showed no discernible impact on either male or female fertility.

Clinical Studies:

A ten-week, double-blind controlled trial with 165 participants investigated how beneficial various therapies for acne were compared to one another. The study included:

• A gel containing three percent Erythromycin.

• Five percent Benzoyl peroxide.

• A combination of five percent Benzoyl peroxide gel and three percent Erythromycin gel.

• A gel vehicle serves as the control.

The outcomes showed that the Erythromycin and Benzoyl peroxide gels performed better in treating acne than the control gel. The combination product, which included five percent Benzoyl peroxide and three percent Erythromycin, was particularly effective compared to all separate treatments. This was more beneficial for papular and pustular lesions but had the greatest effect on combined inflammatory lesions (papules and pustules). According to the results, during the 10-week trial, the combination therapy appeared to be the most effective at treating acne.

Drug Interactions:

Topical Erythromycin and Benzoyl peroxide should not be used simultaneously when receiving tretinoin (Retin-A) therapy since this combination may cause severe skin irritation. Despite the low likelihood of interactions between injectable or oral medications and topically applied Erythromycin and benzoyl peroxide, people should be aware of the possibility of such interactions. To guarantee safety and prevent bad reactions, people should exercise caution and tell their healthcare professionals about all their medications.

Warnings and Precautions:

• Pseudomembranous colitis is a disorder that can result from using specific antibiotics, such as Erythromycin. It can range from moderate to quite serious. It is crucial to consider this if someone experiences diarrhea after taking antibiotics. Antibiotics can upset the normal harmony of bacteria in the colon, leading to the uncontrollable growth of some dangerous bacteria, such as Clostridium difficile. One of the main causes of antibiotic-associated colitis is the toxins these bacteria release.

• Treatment for pseudomembranous colitis should begin upon diagnosis. If the antibiotic is stopped alone, mild cases could improve. Supplemental treatments such as electrolytes, water, and protein supplements could be required in more severe cases. The physician may also recommend an additional antibiotic particularly useful in treating Clostridium difficile colitis. The objectives are to restore a healthy balance of microorganisms in the colon and reduce symptoms.

Specific Considerations:

• Pregnancy - No studies have been conducted on the effects of topical gel of Erythromycin and Benzoyl peroxide on animal reproduction. Erythromycin base, up to 0.25 percent of the diet, had no harmful effects on reproduction in experiments conducted on female rats. However, there are no conclusive results from well-controlled trials about the topical gel in expectant mothers. The potential risks of topical gel to a growing fetus are unknown. As a result, it should be applied to expectant mothers only in extreme cases. In such situations, speaking with a healthcare provider to assess the advantages and disadvantages is important.

• Nursing Mother - The possibility of Erythromycin and Benzoyl peroxide topical gel being eliminated in human milk following topical administration is unknown. On the other hand, Erythromycin is eliminated from human milk after being administered orally and intravenously. Consequently, care should be taken while giving Erythromycin to a nursing mother.

• Pediatric Population - It is unknown if this product is safe and effective for pediatric patients under twelve.