Retinoid + topical antibiotic Pregnancy: Contraindicated in pregnancy and in women planning a pregnancy; if the patient becomes pregnant during treatment, discontinue. Orally administered retinoids have been associated with congenital abnormalities; topical retinoids are generally assumed to give low systemic exposure, but damaged skin barrier or excessive use may increase exposure. Should be avoided in women who are breast-feeding.

Tretinoin with erythromycin

Brand names: Aknemycin Plus

A fixed-combination topical preparation of the retinoid tretinoin with the macrolide antibiotic erythromycin, used to treat acne vulgaris with mixed comedonal and inflammatory lesions.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Apply to the affected areas (the SPC does not specify a quantity per application)

Route: Topical (cutaneous) — for application to the skin; the applicator allows direct administration to the skin

Frequency: Once or twice daily

Max: Treatment should continue for 9–12 weeks according to the condition of the skin; excess application should be avoided as it may result in marked erythema, drying and discomfort of the treated areas

eMC (Aknemycin Plus — erythromycin with tretinoin, cutaneous solution). The SPC states 'The dosage is the same for all ages'; no separate paediatric regimen and no per-kg dose is given. Therapeutic improvement may not be observed for several weeks after starting treatment; consistent application makes a significant contribution to the success of therapy. Avoid contact with the eyes or eyelids — if this occurs, rinse thoroughly with water. Avoid accumulation of the product in skin folds or in the angles of the nose. Photosensitivity may occur — minimise sun exposure and avoid sun lamps/sun beds; patients with sunburn should not use the product until recovered. Contains 752 mg of alcohol (ethanol) per ml, which may cause a burning sensation on damaged skin — do not light a cigarette or expose to flame until the medicine has dried completely. Press the top of the screw cap on the foam pad before each use until a 'click' is felt.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients
A family history of cutaneous epithelioma
Acute eczemas, rosacea and acute inflammatory conditions of the skin, especially around the mouth
Underlying sunburn
Concomitant use with other skin medications, particularly those containing keratolytic agents
Pregnancy, and women planning a pregnancy

Side effects

Skin irritation in the form of erythema, burning, drying or peeling of the skin (rare)
Hypersensitivity reaction / allergic contact eczema (very rare)
Apparent deterioration in acne with an increase in inflammatory symptoms at the start of treatment — usually transitory; reduce the frequency of application rather than interrupting treatment
Temporary hypopigmentation or hyperpigmentation (rare); temporary depigmentation possible in non-Caucasians
Acute generalised exanthematous pustulosis (AGEP) — frequency not known; discontinue and institute appropriate therapy if an allergic reaction occurs

Interactions

Skin irritation may be enhanced by UV rays (natural sunlight, sun lamps, sun beds), X-rays, or by bathing in chlorinated or salt water
Should not be used concomitantly with other skin medications, particularly those containing keratolytic agents (contraindicated) — may exacerbate existing skin irritation
Any sunburn should be allowed to heal before starting treatment

Clinical monograph

How it works

Tretinoin normalises follicular keratinocyte turnover to clear and prevent comedones, while erythromycin reduces Cutibacterium acnes colonisation and the associated inflammatory response; the retinoid helps reduce the risk of antibiotic resistance.

Prescribing in practice

The retinoid component makes it contraindicated in pregnancy, and women of child-bearing potential should use effective contraception.
Topical antibiotic therapy should be time-limited and is best paired with benzoyl peroxide rather than used alone, to reduce the risk of antimicrobial resistance.
Local irritation, dryness, peeling and increased photosensitivity are common, so advise sun protection and avoid application to broken or inflamed skin.

Monitoring

No laboratory monitoring is required; review the acne response and skin tolerance and avoid prolonged courses of the antibiotic component.

Counselling the patient

Apply a thin layer across the whole affected area at night and protect the skin from the sun during the day.
Mild dryness and irritation usually settle; allow several weeks to see benefit.
Avoid in pregnancy or when trying to conceive.

Evidence & guidelines

Fixed combinations of a topical retinoid with a topical antibiotic are recommended by NICE for acne, with antibiotic duration minimised to limit resistance.

Reference: NICE NG198; 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Tretinoin with clindamycin · Retinoid + topical antibiotic

Pathways