Systemic antibiotics for treating acne
Inflammatory acne lesions respond well to systemic antibiotics, especially those in the tetracycline family. This includes tetracycline, doxycycline and minocycline. Other antibiotics, such as erythromycin, Bactrim, and Keflex are sometimes used as well.
Minocycline for acne
The antibiotic for acne most used by dermatologists is minocycline, available as a generic, but also as the brands Dynacin, Minocin, Minocin PAC, Myrac, Solodyn, and Vectrin. Typically a delayed release formulation, such as Solodyn or Minocycline ER is used, but insurance coverage can sometimes be difficult. A typical starting does of extended-release minocycline is 1mg/kg. Often minocycline is dosed at 100 mg daily.
Doxycycline for acne
Systemic doxycycline is often used in the treatment of acne. It is available as a generic, and also under the brands Adoxa, Alodox, Avidoxy, Doryx, Monodox, Oracea, Oraxyl, Periostat, and Vibramycin. It is often used in a low dose extended release formulation, such as Oracea, when treating rosacea. It is more often dosed at 100 mg per day when treating acne.
Seysara for acne
Seysara (sarecycline) is a newer tetracycline class medication for acne. It is similar to minocycline but is said to target a narrower range of bacteria, possibly resulting in less antibiotic resistance.
Bactrim for acne
Bactrim (sulfamethoxazole and trimethoprim) is sometimes used for resistant acne and for gram-negative folliculitis.
Erythromycin for acne
Erythromycin can also be used to treat acne. Unlike the doxycyclines, which are pregnancy category D, erythromycin is pregnancy Category B.
Other antibiotics for acne
Depending on your specific acne, your dermatologist may choose other antibiotics as well.
How long do you take antibiotics for acne?
When treating acne with systemic antibiotics, it is not like treating a sore throat for a week or ten days. When treating acne with systemic antibiotics, treatment is usually for several months. At some point, if you are doing well, an attempt will be made to discontinue the systemic antibiotics. But many patients require the systemic antibiotics long-term, or are on and off the drugs on a periodic basis.
Is it safe to take systemic antibiotics for acne?
Overall taking systemic antibiotics for acne is well-tolerate. But all medications, including systemic antibiotics have risks. Generally the most concerning of these is a possible allergic reaction. It is rare, but it can happen. If you develop a rash while taking an antibiotic for acne, stop the medication immediately and notify your dermatologist. An allergic reaction can often look like hives or like a typical maculo-papular drug rash. Taking systemic antibiotics for acne can sometimes cause stomach upset, and can also increase the risk of yeast infection in women. People that take systemic antibiotics for acne also have a slightly higher rate of upper respiratory infections. Read the medication label, and discuss your concerns with your dermatologist.
Why are antibiotic doses for acne lower than normal antibiotic doses?
When treating acne with systemic antibiotics, it is usual to use a dose that is lower than used to fight infection. The reason for this is that many antibiotics, especially the tetracycline family, have anti-inflammatory effects as well as antibiotic effects. Acne is considered to be primarily an inflammatory and not an infectious disease. The anti-inflammatory effects of these medications are seen at a lower dose that is needed for the antibiotic effect. For this reason, although the medications are called antibiotics, they can also be thought of as anti-inflammatories in the treatment of acne.
Can systemic antibiotics for acne be combined with other medications and acne treatments?
Systemic antibiotics for acne are typically used in conjunction with topical medications. Sometimes light therapy for acne is used as well, as are simultaneous treatments for scarring or hyperpigmentation.
