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Oral Antibiotic Drug Treatment for Acne

As acne becomes more severe, the potential to scar and disfigure increases exponentially. Young adults who suffer severe acne may also suffer social and psychological damage, especially if the acne attacks are concentrated on the face. It is therefore imperative to treat inflammatory acne immediately and properly. While there are various systemic treatments available, oral antibiotics are recommended for moderate to severe types of acne, as well as in the following cases:

  • Topical treatment has little or no effect on the acne
  • Acne covers large areas of skin, such as the chest, back, and shoulders.

Tetracycline, and its second generation derivatives minocycline and doxycycline, are among the most common oral antibiotics used in systemic treatment. (Clinical experience and data available to date show that minocycline and doxycycline are more effective than tetracycline). Tetracycline is known to have anti-inflammatory properties and suppresses the growth of Propionibacterium acne and reduces the number of comedones. The effectiveness of the drug is highly dependent on its ability to penetrate the pilosebaceous follicles where the propionibacterium resides. Deeper penetration means better effectivity of oral antibiotics.

The typical duration of oral antibiotic treatment lasts 4 to 6 months. The patient should be forewarned about any possible drug intake that causes violent reaction on his system. It is recommended for women that their acne antibiotics should be administered along with hormonal treatments, especially where oral contraceptives are part of the regimen. The claims that oral antibiotics reduces the efficiency of oral contraceptives is a hearsay since the failure rate of oral contraceptives, according to the literature, is the same with or without antibiotics.


Since tetracycline is generally safe and proven effective in previously untreated case of severe acne, there is no need to monitor healthy patients under this treatment. Scientific experiments yield 60% rate of improvement done on random trials with inflammatory acne. Tetracycline works better when taken with an empty stomach as food intake impedes its absorption rate. It was noted that failures of the treatment only occur whenever: patients do not comply with rules set by the doctor; the treatment duration is insufficient; there is evident development of folliculitis; when there are high sebum secretion leading and higher bacteria resistance.

The three known side effects of tetracycline are gastrointestinal problems, vaginal candidiasis, and photosensitivity with permanent pigmentation on bone and teeth on some cases making it not being recommended on pregnant women and children below 12 years of age after general complaints of frequent abdominal pain is noted.


The most frequently prescribed oral antibiotic is Minocycline because the response to its use in treatment protocols is quicker and because it quickly penetrates the pilosebaceous hair follicles. Unlike tetracycline, minocycline can be taken with meals as food affects its absorption less. It is one of the most expensive drugs on the market, which can be an issue in countries with public state health care systems, as seen on the very minimal number of support it has in being the first choice in oral antibiotic treatment. Though minocycline is effective in moderate acne, its effectivity relative to other treatments is still undetermined.

Furthermore, Minocycline causes headaches, vertigo, and hyperpigmentation of the skin and some allergic reactions, and very rarely autoimmune disorders like autoimmune hepatitis, hypersensitivity reactions like hepatitis and pneumonitis. Certain cases are reported where it causes death due to hepatoxicity and myocardial necrosis! Somehow, gastrointestinal problems are much less compared to those caused by tetracycline since minocycline is absorbed readily by the body. Patients on minocycline should be checked every 3 to 4 months for liver function and antinuclear factor in their blood.


Like Minocycline, Doxicycline penetrates the pilosebaceous follicles as well as minocycline and can be administered on an empty stomach. Among the three drugs, doxicycline is most likely to cause dose dependent photosensitivity reactions.

Low dose administration of doxicycline was found to be effective and safe since the risks of developing side effects are as low as the development of bacterial resistance. If further studies confirm this benefit, it is likely that lower doses will become standard.

Bacterial Resistance

The increasing bacterial resistance on antibiotic treatment of acne has been noted as several studies. A main objective of acne treatment research these days is to lower and impede bacterial resistance. Compared to other antibiotics such as erythromycin, resistance is less common with tetracycline and doxicycline and rare with minocycline. Some strategies adopted for reducing resistance with oral antibiotics are:

  • minimizing use of antibiotics
  • discontinuing oral antibiotics when acne control is achieved
  • prescribing the same oral antibiotic for re-treatment