Minocycline Dosing for Acne and Skin Infections
Recommended Dosing Regimens
For acne vulgaris, use minocycline 50-100 mg once or twice daily (maximum 200 mg/day), and for skin/soft tissue infections including MRSA, use 100 mg twice daily. 1
Acne Vulgaris Dosing
- Adults: 50 mg 1-3 times daily is the standard recommendation, with dosing up to 100 mg twice daily for more severe inflammatory acne 1, 2
- Pediatric patients ≥8 years and <45 kg: Initial dose of 4 mg/kg followed by 2 mg/kg every 12 hours 1, 2
- Pediatric patients ≥8 years and ≥45 kg: Use adult dosing of 100 mg twice daily 1
Skin and Soft Tissue Infections (Including MRSA)
- Adults: 100 mg orally twice daily for 7-14 days, with an optional 200 mg loading dose initially 1
- Pediatric patients ≥8 years and <45 kg: 2 mg/kg/dose every 12 hours 1
- Pediatric patients ≥8 years and ≥45 kg: Adult dosing of 100 mg twice daily 1
Critical Treatment Principles
Never use minocycline as monotherapy for acne—this violates antibiotic stewardship principles and promotes resistance. 2
- Minocycline must be combined with topical benzoyl peroxide and/or a retinoid throughout the entire treatment course for acne 2, 3
- Limit systemic antibiotic duration to 3-4 months maximum to minimize bacterial resistance 1, 2
- For skin infections, ensure adequate treatment duration of at least 7 days; inadequate duration is a common pitfall 1
Dosing Hierarchy and Selection
The American Academy of Dermatology gives doxycycline a strong recommendation versus minocycline a conditional recommendation due to concerns about rare but serious adverse effects. 2
- Consider minocycline as second-line after doxycycline for acne treatment 1
- Minocycline offers advantages of less gastrointestinal disturbance and photosensitivity compared to doxycycline 2
- However, minocycline carries higher risk of vestibular disturbances, autoimmune hepatitis, drug-induced lupus, hypersensitivity syndrome, and skin hyperpigmentation 2
Absolute Contraindications
- Children <8 years of age: Risk of permanent tooth discoloration and enamel hypoplasia 1, 4
- Pregnancy (Category D): Contraindicated in pregnancy and breastfeeding 1, 2
- Hypersensitivity to tetracyclines 4
Monitoring Requirements
- Complete blood count (CBC): Weekly for first 2 months, then monthly if stable 1
- Liver function tests: Monitor especially with prolonged use 1
- Clinical response: Improvement typically begins within 1-2 weeks 2
- Adverse effects requiring cessation: Occur in 9.1% of patients versus 1.0% with placebo 2
Common Pitfalls to Avoid
- Do not administer with antacids, calcium, magnesium, or iron-containing preparations—these reduce absorption 1
- Avoid concurrent use with isotretinoin and methoxyflurane 1
- Use caution with oral anticoagulants due to drug interactions 1
- Monitor for photosensitivity: Advise patients to avoid direct sunlight or UV radiation 1, 4
Dose-Related Safety Considerations
Higher doses (200 mg daily) are associated with increased risk of pigmentation, which occurs only after cumulative doses exceeding 70 grams. 5