Although in most of the mild cases of acne over the counter acne products or prescription topical therapies alone can be very effective, there are often cases for which oral antibiotics are needed to control disease. As for severe kind of acne combination of oral antibiotics with other drugs like retinoids and benzoyl peroxide can be highly effective. Patients and their parents often have many questions regarding the safety and efficacy of long-term use of antibiotics for acne. It is of much importance to get a thorough understanding of the antibiotics and their side effects.
Antibiotics therapy for acne cannot be truly evaluated until 6-8 weeks after starting. Antibiotics level in sebum are not detectable until approximately 7 days after treatment has started, and in addition, lipid formed in basal cells of sebaceous follicles may require 1 months to reach the skin surface.Although sebum composition changes,the rate of secretion remains constant,Therefore skin may remain oily. Therapy may need to continue for several months.So it is important to use the full antibiotics dose as prescribe.It is controversial whether to taper the oral antibiotics or to stop with no taper. Tapering may allow organism to grow more redily.Long term use of antibiotics likely contributes to the pool of resistant organism.
Oral antibiotics may also decrease the effectiveness of oral contraceptives.Some study suggest that long term use of antibiotics might be associated with increase risk of breast cancer in women.So the therapy should be limited and long term maintainance therapy should follow on topical or other medications.
Commonly Used Antibiotics for Acne.
Tetracycline: It is the first line of antibiotic prescribed as its cheap and well tolerated for longer period of time.It is effective in low dose because high concentration are achived within sebaceous follicles,especially when inflammation is present.
Apart from minor gastrointestinal irritation, Candida vaginitis is a common complication.Although tetracycline can cause enamel hyperplasia and hence tooth discoloration,by age 12,growth of teeth is essentially complete.Tetracycline should never be used in younger children nor be administered during pregnancy.The duration of treatment can be from 2 weeks to 10 months.Some presenting symptoms might be headache,nausea,vomiting and double vision.
Erythromycin: Erythromycin 1g/day (in divided dose ) is also effective in the treatment of acne.It has several advantages over tetracycline but 40% of P.acnes organism are resistant to erythromycin.So combination with topical benzoyl peroxide help decrease resistant to erythromycin.
Minocycline: They are useful but quite expensive antibiotics used in patients unresponsive to other medications.It is overall the most effective antibiotics to treat acne but it can have some serious side effects.This antibiotics is lipophilic is nature so it crosses blood brain barrier and can precipiate pseudotumor cerebri syndrome.the duration of therapy can be weeks to year with most common presentation being headache,nausea,vomiting,visual distrubance.
Minocycline causes blue discoloration of acne cyst or sites of trauma,this discoloration usually doesn’t appear until 8 months of therapy with a total commulative dose of 70g and usually reversed after discontinuing drug.Once the cumulative dose of 100g is reached,alternate therapy should be considered.
Doxycycline: This is often used for people who can’t tolerate tetracycline or other drugs.It is as effective as minocycline if taken in similar manner and dosage like minocycline.Peoples using doxycycline should not be exposed to sun because of its photosensitivity and cause sun burn.
Clindamycin: Clindamycin is extremely effective against acne.However due to major side effects like pseudomembranous colitis it has been limited to topical therapy ,systemic therapy only given when all drugs fails.
Azithromycin: Azithromycin in 500mg dose three times a week has been shown to yield a 60% reuction is inflammatory papules in 83% of patients inrolled in 12 weeks study.There is no associated pseudotumor cerebri and therefore can be used for an acne flare during early Accutane therapy.
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