Abstract

Background: Acne vulgaris has been treated usually with antibiotics. Propionibacterium acnes (P. acnes) play a crucial role in its pathogenesis, however, P. acnes has been described to develop antibiotic resistance. Objective: To assess the antibacterial effect of certain antiseptics such as hydrogen peroxide, apple cider vinegar and honey in combination of specific antibiotic on P. acnes, to decrease its resistance. Method: Acne samples were cultured under anaerobic condition to isolate and identify P. acnes, using microscopic investigations, biochemical tests and molecular identification. Susceptibility tests of the isolated P. acnes against various antibiotics were performed using disc diffusion and Minimum inhibitory concentrations (MICs) assays. Antibiotic/antiseptic combination effect was determined using checkerboards analysis. Results: P. acnes were isolated from 68 out of 186 specimens (36.5%). Resistance of P.acnes isolates to Clindamycin is increasing (72.25%), although P. acnes showed susceptibility to other antibiotics. Hydrogen peroxide/Clindamycin Combination showed synergism in 83.3% of the isolates, with a fractional inhibitory concentration index (FICI) of 0.348. While, combination of Clindamycin with honey or apple cider vinegar give synergism in 25% and 2.9% of the isolates respectively . Conclusion: The combination of hydrogen peroxide with Clindamycin has potential in vitro activity to overcome Clindamycin resistance in P. acnes.