Acne vulgaris is one of the most common chronic inflammatory conditions managed in primary care. In the UK, acne accounts for approximately 3 million GP consultations annually, predominantly among adolescents and younger adults. Global prevalence continues to rise, particularly in those aged 15–19 years. As most acne is managed in general practice, adherence to evidence-based guidance is essential to optimise outcomes and minimise unnecessary antibiotic exposure. NICE NG198 provides clear standards for topical therapy, antibiotic prescribing, follow-up, and referral, supporting antimicrobial stewardship in primary care.To assess adherence in a UK general practice to NICE NG198 guidance for acne vulgaris, focusing on first-line topical management, systemic antibiotic use, follow-up practices, and referral of severe or refractory disease.A retrospective, single-centre audit was conducted between April 2024 and April 2025. Patients with a coded diagnosis of acne vulgaris were included if sufficient clinical data was available. Data collected included demographics, acne severity, treatment initiated, systemic antibiotic use, follow-up within 12 weeks, and referrals to dermatology. Performance was descriptively assessed against NICE standards.First-line management: Most patients were initiated on guideline-recommended topical therapy. Antibiotic prescribing: Systemic antibiotics were largely prescribed in line with guidance and were predominantly tetracycline-based; however, a small but clinically relevant proportion commenced oral antibiotics as first-line therapy. Follow-up: Most patients were reviewed within the recommended 8–12 weeks, though documentation was inconsistent. Referral: Nearly all patients with severe acne were appropriately referred to dermatology.This audit demonstrated strong overall adherence to NICE guidelines, particularly for topical first-line therapy and referral practices. However, even infrequent initiation of systemic antibiotics first-line has antimicrobial stewardship implications when scaled across the high volume of acne consultations. Inconsistent follow-up documentation may increase the risk of prolonged or unnecessary antibiotic exposure. Targeted interventions, including improved documentation templates and prescribing prompts, could strengthen guideline adherence.With millions of acne consultations managed annually in UK general practice, small deviations from guideline-based care can have substantial population-level consequences. Clear communication and reinforcement of evidence-based acne management are essential to support antimicrobial stewardship, optimise patient outcomes, and strengthen the role of primary care in delivering high-quality dermatological care.