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Topical antibiotic + zinc (acne) Pregnancy: Can be used during pregnancy and during breast-feeding, but should not be used on the chest.

Erythromycin with zinc acetate

Brand names: Zineryt

This is a topical combination solution of the macrolide antibacterial erythromycin with zinc acetate, applied to the skin for inflammatory acne vulgaris.

Adult dose

Dose: Erythromycin/zinc acetate 40 mg/12 mg powder and solvent for cutaneous solution — apply over the whole of the affected area
Route: Cutaneous (topical)
Frequency: Twice daily
Treatment period is 10 to 12 weeks. Avoid contact with the eyes or the mucous membranes of the nose and mouth. Cross-resistance may occur with other macrolide antibiotics and also with lincomycin and clindamycin. The SPC gives a single posology with no separate adult/paediatric or elderly regimen and no dose adjustment for renal or hepatic impairment.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substances, to other macrolide antibiotics, or to any of the excipients

Side effects

  • Pruritus (rare)
  • Erythema (rare)
  • Skin irritation and skin burning sensation
  • Dry skin
  • Skin exfoliation
  • Hypersensitivity; acute generalised exanthematous pustulosis (AGEP) reported after systemic administration

Interactions

  • No interaction studies have been performed (SPC section 4.5)

Clinical monograph

How it works

Erythromycin inhibits bacterial protein synthesis to suppress Cutibacterium acnes and reduce inflammation, while zinc acetate improves cutaneous penetration and may itself contribute anti-inflammatory and astringent effects.

Prescribing in practice

  • As with all topical antibiotics for acne, it should be combined with benzoyl peroxide and used in time-limited courses to minimise antibiotic resistance rather than as prolonged monotherapy.
  • Avoid combining with other antibiotics of a different class to reduce selection of resistant organisms.
  • Apply across the whole affected area and avoid contact with the eyes, lips and mucous membranes.

Monitoring

No laboratory monitoring is required; review acne response, local tolerability and the continued need for treatment to limit resistance.

Counselling the patient

  • Reconstitute and apply the solution as directed to the entire affected area of clean, dry skin.
  • Mild dryness, redness or a burning sensation can occur and usually settles.
  • Keep using benzoyl peroxide as advised and complete the agreed course to reduce the chance of resistance.

Evidence & guidelines

Topical erythromycin with zinc has been used for acne with supporting clinical studies, and NICE recommends pairing topical antibiotics with benzoyl peroxide to limit resistance.

Reference: NICE NG198; BAD acne guidance; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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