Oral antibiotics are used for severe to moderate adult acne and also in instances where topical preparations are not sufficient. These are prescription only medicines and should not be administered without an advice from your dermatologist/doctor. These preparation’s side effects can be severe and due to this reason you should immediately stop taking them.
Stomach upset is the most frequent side effect with all the antibiotics and they may interfere with your ongoing medication (for example, the oral contraceptive pill and some anticoagulants). They may have to be taken for long durations. (6 months to a year is very common). A lot of people find that as soon as they stop therapy with an antibiotic, their acne returns.
OXYTETRACYCLINE
This seems to be the choice preparation when an antibiotic is first tried. Some metals tend to bind with this antibiotic and make a complex that stops its body absorption. It is therefore significant to avoid taking this antibiotic with calcium, iron, and some antacids that may comprise calcium and aluminum. While using this antibiotic, one needs to avoid dairy products containing calcium.
However, you should be aware that any of these products may be used/taken ONE hour before or TWO hours after the antibiotic intake. It is significant to avoid them TOGETHER. This antibiotic is generally prescribed to be taken four times daily, at least half to one hour before any food and can be very tough to achieve. Some doctors prescribe the entire dose as a single dose in the morning, before breakfast.
TETRACYCLINE
This antibiotic has the same profile of oxyteracycline.
DOXYCYCLINE
This antibiotic works just like oxytetracycline but has the advantage of a single daily dosage. It may cause a photosensitive reaction on a bright day during the summer months. It will appear to be more costly than oxytetracycline.
LYMECYCLINE
This is an improved version of Tetracycline with the advantage of having a suitable once a day dosage. It has same profile to MINOCYCLINE and is bit inexpensive. (Although more costly than Tetracycline or Oxytetracycline)
MINOCYCLINE
This antibiotic is frequently used in adult acne treatment and has been found very useful in majority of cases. It shall be taken as a single once a day dose but is often prescribed at a lower dose to times daily. This antibiotic’s high dosage may lead to skin pigmentation (slate grey, purple, blue-black, or brownish colouration).
ERYTHROMYCIN
Erythromycin is not commonly used to treat acne before the other antibiotics have been tried. However, it is one antibiotic which is safe during pregnancy. The main disadvantage with this antibiotic is that it interacts with a lot of other medications and may not be suitable for long-term treatment in some cases.
TRIMETHOPRIM
This antibiotic is quite useful for adult acne treatment but has to be used at a high dose to be efficient (up to 300mg twice a day). With the high dose comes side effects and so is rarely prescribed.
The treatment course usually lasts three to four months and occasionally up to six months.
Trimethoprim is very efficient for acne treatment and is often used along with topical preparations for acne, particularly Clindamycin (found in products such as Zindaclin gel, Dalacin-T lotion, and Duac single day Gel)
Other topical preparations such as Devina`s Choice peel may be added to accelerate treatment. This approach is mainly good since the product contains natural essential oils which are immune Antibiotic resistance problems.
Trimethoprim side effects are mainly related to the Gastrointestinal System and include vomiting, nausea, diarrhea, and appetite loss. Some patients develop severe diarrhoea, colon inflammation or hazardous allergic reactions such as a rash from Trimethoprim.
It’s long-term use is connected with potentially severe unpleasant effects (like blood disorders), so it is commonly only considered as a last resort when other Antibiotics have stopped responding (often due to Antibiotic resistance).
Trimethoprim acts by blocking the metabolism of Folic acid in the Bacterial cell, leading to destruction of the Cell wall. However, this action is not 100% selective for Bacteria and may also affect instantly growing cells in Human Beings. Due to this reason, it is best avoided during pregnancy.
Trimethoprim is frequently found in combination products such as SEPTRIN and BACTRIM. These products are reserved for particular Lung and Throat infections and best avoided for the Acne treatment.
Trimethoprim is available as one ingredient product as well and this is the most sought after treatment choice for adult acne. It is not wise to use the combination products for the Acne treatment due to unimportant side effects and antibiotic resistance.
The following is an extract from the book, “100 Questions & Answers about Acne” by Dr.Doris. I felt that after reading her book, it’s important to present this information here for you on oral antibiotics.
When should I consider taking oral antibiotics?
Topical or systemic medications? The choice is made based on the presence, extent, and how severe the inflammatory lesions are. For best results, antimicrobial agents should be combined with topical retinoids and a topical BP product. This increases efficacy, shortens the treatment duration and helps prevent antibiotic resistance.
In the new age of acne treatment, combination therapy is generally the rule. This means that you should be on more than one type of medication at any given time. Because BP is so effective at minimizing resistance to P.acnes, it helps maintain the effectiveness of both oral and topical antibiotics and should be used along with them unless there is an allergy to BP. In those cases, BP is not an option, and other treatments are used.
The main indication for oral antibiotics is moderate to severe inflammatory acne. Tetracyclines are the most commonly used family of antibiotics along with a class of antibiotics known as macrolides, and a third class called sulfonamides.
Topical antibiotics and BP are indicated in people with mild to moderate inflammatory acne. It is highly recommended that topical treatments, such as with BP and azelaic acid or retinoids, be used in combination with oral antibiotics in order to speed the treatment results and to minimize the resistance of the bacteria to the antibiotic.
Oral antibiotics work by reducing the number of P.acnes and Staphylococcus epidermidis in the skin. P.acnes is thought to trigger the inflammatory response in acne and therefore plays an important role in the formation of acne lesions. Also, antibiotics have an anti-inflammatory activity, which makes them especially useful in inflammatory acne treatment.
Oral Antibiotics Commonly Used for Acne
- Tetracyclines
- Tetracycline (generic)
- Lymecycline
- Doxycycline
- Periostat
- Doryx
- Minocycline
- Dynacin
- Macrolides
- Erythromycin
- Clindamycin
- Azithromycin
- Sulfonamides
- Trimethoprim/sulfamethoxazole (Bactrim)
- Cotrimoxazole
When taking an oral antibiotic, it is important to know the dose you are taking and how many times a day you should take the medicine. Also, it is generally not a good idea to take these medications right before bedtime because this can lead to an irritation of the esophagus. Esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach.
Esophagitis, or inflammation of the esophagus, can occur from oral antibiotics, other medications, or even food taken or eaten too soon before bedtime, with some oral antibiotics being more at risk for causing this than others. It is most commonly reversible, and stopping the medicine is often curative.
It does serve as a strong reminder to take medications only as directed and to not share your medicines with friends or family. Be sure to tell your doctor about any side effects that you may be having, as the medication may need to be adjusted or stopped and changed to a different, more appropriate therapy.
Before considering starting any oral antibiotic therapy, it is very important to review with your doctor any medications to which you are or think you might be allergic. There can be several medications with names that sound very different that may be within the same class or family of drugs and should be avoided if there is an allergy to any of the medications in that family.
Also, some medications should not be taken together. Be sure to review with your doctor and pharmacist all the medications you are taking including OTC and herbal preparations, so that any problems with drug interactions can be avoided.
Oral antibiotics are indicated in cases of moderate to severe inflammatory acne or acne that is not responsive to topical treatments alone. This method of treatment is unlikely to be helpful in comedonal acne without an inflammatory component.
Oral antibiotics are usually given for at least 6 to 8 weeks with a maximum of 12 to 18 weeks. In some cases, however, if other therapies are not tolerated and the oral antibiotics are clearly effective, the antibiotic therapy may be continued indefinitely. If retreatment is necessary, use the same antibiotic that was effective previously; otherwise, an alternative antibiotic may be indicated.
Also, avoid using the oral and topical antibiotics at the same time. Oral antibiotics are best used in conjunction with topical BP and topical retinoids. Compliance is essential. Some antibiotics are given once daily, whereas some are indicated twice daily. Some can be taken with food, whereas others should be taken only within a certain amount of time around meals.
What are the most common side effects of oral antibiotics?
The most common side effects of antibiotics include upset stomach and nausea. Other side effects include increased sun sensitivity, headaches, and yeast infections in women. Some antibiotics are more prone to cause some of the side effects than others.
For example, sun sensitivity is more of a problem with the doxycycline family of antibiotics; however, the minocyclines have been associated with an autoimmune condition called lupus erythematosus, which is usually reversed when the medication is stopped.
The erythromycins are known to be more likely to cause stomach upset, even though all antibiotics can cause this. Pseudomembranous colitis is a potentially serious intestinal problem that can uncommonly be caused by any of the antibiotics but is usually associated with clindamycin.
If you get a rash or other symptoms that you think might be due to any medication that you are taking, you should call your doctor immediately for advice. Oral antibiotics should not be combined with isotretinoin because of the potential for a condition called pseudotumor cerebri, which feels like a really bad headache.
Because most antibiotics are digested by the liver, drinking alcohol should be avoided if possible to limit the stress and potential damage to the liver.
How long should I be on oral antibiotics?
The usual minimum duration of therapy is 6 to 8 weeks. The maximum duration is usually approximately 12 to 18 weeks. If other therapies are not well tolerated, however, meaning that they are overly irritating to the skin or not effective, and if the oral antibiotic therapy was working well, your dermatologist may rarely opt to recommend that you continue the oral antibiotic indefinitely.
This is not an ideal option for most people. Periostat is the newer low-dose oral antibiotic that may be the exception to this general rule. Because the dose is so low, the idea is that it can and should be taken over a long period of time because the incidence of side effects is very low and resistance is not a problem.
After a successful course of antibiotics is completed, you should continue the topical regimen that your doctor prescribed to maintain clearance. Often prescription and OTC treatments can be used together and can complement each other very nicely, but you should let your doctor know about all the products that you are using on your skin.
Because there is no cure for acne and because so many factors cause the acne to recur, you may still need to retreat with oral antibiotics on occasion if you should have a flare of acne. In that case, your doctor will most likely recommend that you restart the last antibiotic that was effective and again complete a 12 to 18 week course. This pattern may need to be repeated on and off depending on how you do.
Can I eat right before/after taking my oral antibiotic?
Several advances have taken place in the realm of antibiotic production. Although the original formulation of tetracycline is still available and is very inexpensive relative to the newer products on the market, it must be taken at least 1 hour before or 2 hours after eating any foods that contain dairy products. Otherwise, it will not be absorbed and will not be effective.
Increasingly, doxycycline and minocycline are being used as alternatives to tetracycline, in cases in which there is no response to tetracycline, or if the person is unable to tolerate tetracycline. These newer antibiotics are derivatives of tetracycline.
They appear to be more effective in reducing the P.acnes population and reducing inflammation than tetracyclines, and they are less likely to promote drug resistance. The newer formulations are coated so that they are better tolerated and better absorbed, even if taken with food.
Some antibiotics are even better absorbed and are more effective if taken with food, although you should still avoid taking them with iron or calcium supplements. Each drug has its pluses and minuses, and your doctor will select the one that is right for you depending on your concerns and other health issues.
