From the Guidelines
For severe acne, oral doxycycline is the recommended first-line antibiotic treatment, with a dosage of 100mg once or twice daily, due to its strong recommendation and moderate certainty of evidence 1. When managing severe acne, it is essential to consider the potential benefits and risks of oral antibiotic therapy. The guidelines of care for the management of acne vulgaris strongly recommend oral doxycycline for patients with severe acne 1.
- The recommended dosage of doxycycline is 100mg once or twice daily, and it should be taken with a full glass of water.
- Tetracyclines, such as doxycycline, should be taken on an empty stomach and not with dairy products or iron supplements, as these can reduce absorption.
- Patients should use sun protection, as these medications can increase sun sensitivity.
- Oral antibiotics are usually combined with topical treatments like benzoyl peroxide to prevent antibiotic resistance.
- If there's no improvement after 6-8 weeks, or for very severe acne, referral to a dermatologist for isotretinoin consideration may be necessary. Some key points to consider when prescribing oral antibiotics for severe acne include:
- Limiting the use of systemic antibiotics to the shortest possible duration to minimize the development of bacterial resistance 1.
- Using concomitant topical therapy with benzoyl peroxide or a retinoid with systemic antibiotics and for maintenance after completion of systemic antibiotic therapy 1.
- Avoiding monotherapy with systemic antibiotics, as this can increase the risk of antibiotic resistance 1. It is crucial to weigh the benefits and risks of oral antibiotic therapy and to consider the individual patient's needs and medical history when making treatment decisions.
From the FDA Drug Label
In severe acne, doxycycline may be useful adjunctive therapy. In severe acne, minocycline may be useful adjunctive therapy.
Oral antibiotics for severe acne are doxycycline and minocycline, which may be useful as adjunctive therapy 2 3.
- Key points:
- Doxycycline and minocycline are indicated for severe acne as adjunctive therapy.
- They should be used in conjunction with other treatments for severe acne.
From the Research
Oral Antibiotics for Severe Acne
- Oral antibiotics are commonly used to treat moderate to severe acne vulgaris, particularly when topical treatments are insufficient [ 4, 5 ].
- The most effective oral antibiotics for acne include tetracyclines (such as minocycline and doxycycline), which have anti-inflammatory properties and are effective against Propionibacterium acnes [ 4, 5, 6 ].
- Other oral antibiotics used to treat acne include erythromycin, trimethoprim/sulfamethoxazole, and clindamycin [ 5, 7, 8 ].
Recommended Dosage and Treatment Duration
- The recommended dosage of minocycline for acne treatment is 50-100 mg, once or twice daily, for the non-modified release formulation, and 1 mg/kg daily for the extended-release formulation [ 4 ].
- Oral antibiotics should be used in combination with topical treatments, such as benzoyl peroxide and retinoids, to enhance efficacy and prevent resistance [ 5, 7, 8 ].
- Treatment duration with oral antibiotics typically ranges from 3 to 6 months, with the goal of achieving significant improvement in acne lesions and preventing resistance [ 5, 8 ].
Potential Side Effects and Considerations
- Oral antibiotics can cause side effects, such as nausea, vomiting, dizziness, and hypersensitivity reactions, which should be monitored and managed accordingly [ 4, 5 ].
- The development of antibiotic resistance is a concern, and measures should be taken to prevent it, such as using antibiotics for the recommended duration and avoiding concomitant use of oral and topical chemically-similar antibiotics [ 8 ].