Topical use of antibiotics is currently a widely accepted effective and safe treatment for acne. A review of the articles published in the past 30 years revealed that topical application of antibiotics such as erythromycin, clindamycin or tetracycline showed clinical effectiveness for mild to moderate inflammatory acne, especially when they are combined with zinc, tretinoin or benzoyl peroxide, while they showed little influence on noninflammatory acne. The main mechanism of action of topical antibiotics for acne treatment is inhibition of inflammation caused by bacteria rather than a direct bactericidal effect. The adverse reactions of topical antibiotics are mostly minor and negligible, while special attention should be given to the risk of development of resistant strains of Propionibacterium acnes. The development of new antibiotics is promising and will provide a wider range of therapeutic options for refractory cases.