Antibiotics
Antibiotics are used for inflammatory acne – pink lumps and bumps which may be small or in more serious cases, may appear as nodules or cysts.
Antibiotics have been used in acne management for decades, however there is a recent trend to use shorter courses, usually three to six months of treatment.
Antibiotics work by controlling the bacterial infection that contributes to acne. They also have an anti-inflammatory action, which can reduce the redness, swelling and pain.
Antibiotic gels and lotions are applied directly onto the skin (eg, Clindatec, Eryacne, Dalacin). Those currently used for the treatment of acne contain the active ingredients clindamycin or erythromycin.
They should be used sparingly on a cool, dry face to minimise irritation. Using topical antibiotics avoids any side effects that may occur with oral antibiotics, however they may take longer to become effective.
There is also a combination product (Duac® gel) that combines clindamycin and benzoyl peroxide which has been formulated to protect against the irritation and dryness that benzoyl peroxide may cause.
Antibiotic tablets/capsules include tetracycline (eg, Tetrex Achromycin), doxycycline (eg, Doxy, Doryx, Vibratabs) and minocycline (eg, Minomycin, Akamin). Bactrim is less commonly used by some doctors, as is erythromycin.
A number of different antibiotics are available and a doctor will recommend the most suitable product for you.
If one antibiotic does not improve your acne, your doctor may change you to a different one, which may be more effective.
A four to six week trial is usually needed to work out if a certain treatment will work well. These medications are usually helpful and only occasionally cause significant side effects.
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| Antibiotics - maximise the benefits, reduce the risks |
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| Topical antibiotics work to reduce visible pimples and also help prevent new ones.
Antibiotic gels, solution and lotions will be prescribed by a doctor with instructions - how often to apply it, which parts of the face it should be put on, and for how long. These instructions should be followed carefully.
A thin smear should normally be applied once or twice a day to the entire area affected by acne, not just the spots. This is because topical preparations work to reduce visible pimples but also help prevent new ones. Using them regularly over the entire area will lead to much better control of acne.
Oral antibiotics may work faster and be more effective if large areas are involved, such as acne on the face and body.
Antibiotic tablets or capsules are usually prescribed in a course and should be taken regularly to achieve the best results. Tetracycline or doxycycline increases sensitivity to sunburn so it’s best to take extra precautions to avoid sunburn.
- Try to avoid being in the sun between 10am and 2pm (11am-3pm during daylight saving) particularly in summer;
- Stay in the shade whenever possible;
- Wear a hat and other physical protection such as rash shirts at the beach; and
- Use sunscreen (labelled non-comedogenic and/or non-acnegenic) regularly.
Nausea, diarrhoea, thrush and allergy may affect a small number of people taking oral antibiotics.
Pharmacists will tell you when it’s best to take tablets or capsules and whether or not they should be taken with food. They can also provide some practical tips on how to remember to take medications.
Antibiotics are usually effective so if you’re not seeing any improvements in 8-12 weeks, talk to your doctor.
As with all antibiotics, there is concern that if they are over-used or inappropriately used, strains of the acne bacteria will become resistant to antibiotics, making them ineffective.
Taking antibiotics for the full course as prescribed and applying antibiotic creams and gels as directed will reduce this risk. Combining antibiotic therapy with other acne treatments also helps to protect against antibiotic resistance.
This is the case with the combination of benzoyl peroxide and topical or oral antibiotics.
Another way to improve effectiveness is to use a benzoyl peroxide acne wash when you are using antibiotics. |
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| Side effects with oral antibiotics |
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Over the years, antibiotics have saved millions of lives but like all medications, there can be side effects.
Antibiotics can sometimes cause an allergy. Allergic reactions are more common with minocycline, rare with doxycycline and tetracycline and uncommon with antibiotic gels, solution and lotions.
Anyone with the warning signs or symptoms of allergy including an unexplained fever, sore throat, swollen neck glands and rash should stop the medication and visit the doctor. Other symptoms can include joint pain and swelling, nausea, abdominal discomfort, diarrhoea, headache and shortness of breath.
Occasionally fever, rash, joint swelling and pain, skin ulcers and generally feeling unwell due to minocycline allergy can occur several years after first starting therapy.
In some cases the antibiotics used to treat acne cause headaches. If you think any medications are causing headaches, particularly if they are present in the morning, not quickly relieved with paracetamol and/or associated with blurring of vision or neck stiffness, the medication should be stopped promptly and medical advice sought. |
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