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The excerpt below is from p 2 of 4, but p 4 of 4 exhibits the review of the entire article by Debra Jaliman, MD on April 17, 2014.

Usually, topical antibiotics aren't recommended alone as an acne treatment, as they can increase the risk for antibiotic resistance in skin bacteria. However, using benzoyl peroxide with a topical antibiotic may reduce the chances of developing antibiotic resistance.

[Source:] Substances that kill acne bacteria by inflammation, such as benzoyl peroxide, oil of cloves, and chlorhexidine gluconate. Bacteria don’t develop resistance to these treatments, but they don’t kill as many bacteria, either.

If topical antibiotics can cause antibiotic resistance, why would compounds like benzyl peroxide be less resistible? I ask in general about other compounds, and NOT just benzyl peroxide.

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  • $\begingroup$ Off the top of my head I can think of two explanations. 1: Combination therapy using 2 compounds reduces the likelihood of resistance because bacteria will be less likely to have resistance to both. 2: The compound works through a different mechanism of action, less likely to allow resistance through simple mutations, such as ethanol or bleach. $\endgroup$ – user137 Mar 5 '15 at 21:27
  • $\begingroup$ @user137 Thank you for your comment. You wrote Combination therapy, which the first (WebMD) excerpt does cite. But what about the second which only appears to discuss individual treatments by compounds? $\endgroup$ – Greek - Area 51 Proposal Mar 5 '15 at 21:33
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Antibiotics ARE compounds, and they kill or inhibit the growth of bacteria by specific mechanisms. Each class of antibiotics has specific mechanism of actions. Given enough exposure to these antibiotics compounds, bacteria can develop specific molecular mechanism to nullify their effect, and hence antibiotics resistance. Antibiotics resistance will eventually develop with enough exposure to drive the organism's evolution . Whereas there are combination therapy, there are multi-drug resistance; whereas there are wonder drug, there are super bug.

General disinfectant compounds such as benzoyl peroxide or sodium dodecyl sulfate (in soap and detergent) have no specific molecular target that would differentiate host and intruders and hence can harm bacteria as much as the host cells. They are safe to use only because you have skin to prevent their intake. Since there is no molecular target to mutate to develop resistance, the resistance to general disinfectant will simply take a very long time.

That is to say, who could ensure bacteria cannot develop resistance to benzoyl peroxide? Resistance to phenyl derivative has long been reported [1], and bacterial catalase can easily break down the damaging effect of peroxide.

[1] Heinz Berger and Orville Wyss. J of Bacteriology (1953) vol. 65 p.103

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