When should I consider taking oral antibiotics?

It is known that oral antibiotics are used for moderate to severe inflammatory acne or acne that is not responsive to topical acne treatments alone. Therefore oral antibiotics are not helpful in comedonal acne (i.e. mostly blackheads and whiteheads) without an inflammatory component.

However, in the modern age of acne treatment, a combination of acne therapy is generally the rule. As to oral acne antibiotics, Tetracyclines are the most commonly used family of antibiotics along with a class of antibiotics known as macrolides, and with a third class called sulfonamides. It is good to note that topical antibiotics and BP (i.e. short for benzoyl peroxide, an antiseptic commonly used topically in the treatment of acne as it does not induce bacterial resistance) are indicated in people with mild to moderate inflammatory acne. As such, topical acne treatments, such as with BP and azelaic acid or retinoids, should be used in combination with oral antibiotics in order to speed up our acne treatment result, at the same time this helps to minimize the resistance of the bacteria to the antibiotic.

P acnes, as we may or may not know are the culprit that triggers the inflammatory response in acne and plays an important role in the formation of acne lesions. The effect of oral acne antibiotics is it worked to reduce the number of P acnes and Staphylococcus epidermidis in our skin and is proven useful in inflammatory acne treatment.

What follows is a list of oral antibiotics that is commonly used for acne treatment:

Tetracyclines
Tetracycline (generic)
Lymecycline
Doxycycline - Periostat, Doryx
Minocycline - Dynacin

Macrolides
Erythromycin
Clindamycin
Azithromycin

Sulfonamides
Trimethoprim/sulfamethoxazole (Bactrim)

Cotrimoxazole

Some important facts to know about when we are in oral antibiotics:

1. It is important to know the dose we are taking and how many times a day we should take the medicine. In general, try not to take the oral acne antibiotics right before bedtime as it can lead us to a condition called “Esophagitis,” which is an inflammation of the esophagus, i.e. the connection from our mouth to the stomach.
   
   
2. Some medications should not be taken together; this is to avoid unwanted problems associated with drug interactions. It is advisable to review with our doctor and pharmacist all the medications that we are taking, which shall include over-the-counter and herbal acne preparations. If we are allergy to certain drug, extra precaution should be taken as medications with names that sound very different may still be within the same class or family of drugs.
   
   
3. Oral acne antibiotics are usually given for 6 to 8 weeks but may be extended to the maximum of 18 weeks. However, if other acne therapies are not tolerated and the oral antibiotics prove to be really effective, the oral antibiotic therapy may be continued indefinitely. An alternative oral antibiotic may be required if the one we are taking is not effective from the acne clear and acne care point of view.
   
   
4. It is not advisable to use oral and topical antibiotics at the same time. In fact, oral antibiotics are best used in conjunction with topical BP and topical retinoids.
   
   
5. Compliance is important for better acne control and acne free purposes. For example, some antibiotics are given once daily, whereas some may be more frequent. The timing to take is also important, for example, some can be taken with food whereas others only within a certain amount of time around meals.
   
   
6. BP is acknowledged to be very effective for resistance to P. acnes. Also, it helps to maintain the effectiveness of both oral and topical antibiotics, therefore should be used along with them unless there is an allergy to BP, of which other acne treatments are used.