The pathogenesis of acne involves numerous pathophysiological components, including increased sebum production, abnormal keratinization of epithelial cells at the follicular opening, microbial colonization, and inflammatory and immune responses. Microbial colonization is thought to be an important cause of inflammatory lesions such as papules, pustules, and nodules. Different antibacterial drugs can be chosen in acne treatment, but the choice of drug must take into account the pathogenesis of acne and the different pathological and physiological conditions of the patient. Overall, the following are important bases for choosing antibiotics. 1. Antibacterial effect is the key to ensure efficacy. Antibiotics for the treatment of acne rely on both their antibacterial effect and their nonspecific anti-inflammatory effect, especially the tetracyclines. Currently, there are tetracyclines, macrolides, clindamycin, cotrimoxazole and quinolones among the antibacterial drugs available in the clinic. Among them, tetracyclines and macrolides are commonly used. Given that macrolide antibiotics, especially erythromycin, have significantly increased resistance, and that increased resistance is closely related to reduced efficacy and cross-resistance with clindamycin, their use is restricted. The first generation of tetracyclines such as tetracycline resistance has also increased significantly, while the second generation such as minocycline, doxycycline and lymecycline have high antibacterial activity and low resistance, and also have clear non-specific anti-inflammatory effects, so they are recommended as the first choice in the global consensus for the treatment of acne. 2. The effective penetration of antibiotics into the hair follicles and sebaceous glands is the prerequisite to ensure the antibacterial effect. In vitro research found that tetracyclines, erythromycin, cephalosporins, quinolones and other drugs are very strong antibacterial activity, the study found that minocycline in the hair follicles, sebaceous glands in the highest concentration, followed by erythromycin. And penicillins including cephalosporins are difficult to penetrate into hair follicles and sebaceous glands. 3. Adverse drug reactions limit the antibiotic treatment of acne. General adverse reactions can mostly be relieved after stopping the drug, and the majority of serious adverse reactions are also reversible. It is recommended that patients taking minocycline for a long time should be regularly tested for relevant immunological indicators under the guidance of a doctor. Macrocyclic ester antibiotics also have gastrointestinal discomfort, liver toxicity, tinnitus, hearing impairment and drug metabolic reactions. Therefore, when tetracyclines and macrolide antibiotics are clinically applied to treat acne, they are mostly advocated to be taken after meals, and attention should be paid to their toxicity to the liver. At the same time, because tetracyclines affect the development of teeth and bones, they should be prohibited for children under 14 years old, and erythromycin can be used instead. The following principles should be followed in use: 1. Antibiotics alone should not be used for acne, especially to avoid long-term topical application alone; 2. Adequate doses should be given at the beginning of treatment; 3. Antibiotics should be discontinued or replaced promptly when ineffective 2-3 weeks after treatment, and attention should be paid to patient compliance and gram-negative bacillary folliculitis; 4. A sufficient course of treatment should be ensured, usually more than 6 weeks of continuous use but not more than 12 weeks, and avoid Intermittent use; therefore not unprincipled increase the dose of antibiotics used or extend the course of treatment, not to mention as maintenance treatment or even relapse prevention measures; 5, to emphasize to patients the importance of medication compliance and the correct method of medication; 6, commonly used antibiotics such as macrolides, tetracycline or doxycycline when the efficacy is not good, should take into account the generation of resistance, and timely replacement of antibiotics such as minocycline; 7, combined Other antibiotic treatment, especially anti-drug resistance and other treatment. For example, intermittent topical peroxymethylphenidate gel for 5-7 days, or oral isotretinoin to reduce the generation of drug resistance. In conclusion, acne antibiotic therapy should follow the principles of antibiotic application in general anti-infection treatment, reasonable and standardized use, prevention of abuse, and reduction of drug resistance generation and incidence of adverse drug reactions.