BACKGROUND: The mainstay of mild to moderate acne treatment is topical antibiotics. A new combination of 2% erythromycin and 1% bifonazole was tested in a double-blind trial against erythromycin alone. METHODS: A total of 207 acne patients were recruited into the study and 157 (76%) completed the full trial protocol of 12 weeks of treatment. In all, 74 patients applied the combination solution (erythromycin + bifonazole) once a day and 83 patients applied erythromycin solution twice a day. Outcome parameters measured were lesion-count (open and closed comedones, papules and pustules) and acne grading using the Cook's acne scale, carried out at the initial visit, and at the 4, 8 and 12-week follow-up visits. RESULTS: Both treatment groups improved significantly over baseline and showed continuous improvement throughout the trial, with the erythromycin + bifonazole group showing better improvement than the erythromycin group. At the end of 12 weeks, open comedones, closed comedones, papules and pustules wer...