Antibiotics are part of the routine treatment of acne, but not all acne requires antibiotics. Antibiotics are used when acne is actively infected. They reduce infection and inflammation and reduce the chance of scarring.
The bacteria which cause infection in acne are the normal bacteria found commonly on healthy skin. The reason some acne becomes infected and other acne is relatively uninfected is not well understood.
Acne is caused by blocked pores. Secretions build up at the surface of the skin. This produces blackheads and whiteheads. If these become infected, pustules (infected spots) develop. Infected spots are usually red, painful and inflamed.
Acne spots which contain large amount of secretions, usually with infection, are called cysts.
Simple mild acne, with whiteheads and/or blackheads, but little or no infection does NOT normally need antibiotics. It can be treated with topical peeling agents (creams, lotions or gels), which unblock pores and reduce inflammation.
Mild peeling agents can be bought from pharmacies without prescriptions. They contain an active ingredient, benzoyl peroxide. There are dozens of different brands of benzoyl peroxide in strengths, from 2.5% to 10%.
Stronger peeling agents, known as retinoids, are available only on prescription, either through online clinics or GPs, e.g. Isotrex (topical isotretinoin) and Differin (topical adapalene).
Retinoids are also available in tablet form. Retinoid tablets are usually reserved for severe acne in which there are multiple cysts and scarring. They are usually prescribed only on the recommendation of skin specialists. Side effects can be significant and treatment needs to be monitored.
Antibiotics for acne
Topical antibiotic and antibiotic tablets are available only on prescription. They can be obtained in the UK either through regulated online clinics or from GPs. Antibiotics work by reducing infection.
Antibiotics can be used on their own, or in combination with peeling agents, either benzoyl peroxide or retinoids.
Antibiotic creams and antibiotic tables should not usually both be used together at the same time. They have the same actions and duplicate treatment is undesirable. It increases the chances of bacterial resistance and the chances of side effects.
All acne treatments, including antibiotics, take time to work. After 8 weeks, if the is no improvement at all, one treatment can be stopped and a different one started.
Antibiotics should NOT be used for prolonged periods without a change or a break. After a few months bacteria can become resistant. If antibiotic treatment stops working, they should be stopped or changed. The benefits of the treatment sometimes continue after antibiotics are stopped.
After stopping for a few months, if required, antibiotics can be started again.
Topical antibiotics acne treatment
Topical antibiotics (creams, lotions, gels or solutions) are usually tried first, before trying antibiotic tablets. Topical treatments are applied to the whole of an acne affected area once or twice daily.
The most commonly used topical antibiotics for acne are Dalacin T (topical clindamycin) or Zineryt (topical erythromycin). Zineryt contains a type of antibiotic known as a macrolide. Dalacin T is a type of tetracycline. If one type of antibiotic is not working at all after 8 weeks, a different one can be tried.
Topical antibiotics treatments are sometimes combined with peeling agents. A popular combination is Duac (clindamycin with 5% benzoyl peroxide).
Side effects of topical antibiotics
All medicines can produce side effects. The side effects of antibiotic creams, lotions and gels are usually not severe and treatment does not usually need to be stopped. Very little antibiotic is absorbed into the body.
Creams and lotions can be greasy and older topical preparations containing tetracycline can produce temporary skin reddening and increased sensitivity to sunlight.
Antibiotics combined with peeling agents, e.g. Duac, usually cause more irritation than antibiotics on their own. Irritation can be reduced by starting treatment every other day and then building up to the prescribed amount over a few days.
A full list of side effects of antibiotic treatments for acne can be found the manufacturer’s patient information leaflets.
- Dalacin Patient Information Leaflet (PDF)
- Zineryt Patient Information Leaflet (PDF)
- Duac Gel 3% Patient Information Leaflet (PDF)
If acne is getting worse instead of better, a doctor should be consulted, particularly where there is distress or severe acne with scars.
Antibiotic tablets for acne treatment
Antibiotic tablets have an advantage over topical preparations. They are simple to take and nothing needs to be applied to the skin. On the down side, antibiotic is taken into the body, and this can result in side effects. Antibiotic tablets are usually more effective than topical antibiotics, particularly for acne covering large areas.
The antibiotic most widely prescribed by doctors is Lymecycline. Lymecycline is a type of tetracycline. It is a once daily tablet.
An older type of tetracycline tablet, Minocin MR (minocycline), is also sometimes prescribed. This antibiotic can cause more significant side effects and is becoming a less popular with doctors and patients.
Side effects of antibiotic tablets
A full list of the side effects of Lymecyline can be found in the manufacturers leaflet supplied with the tablets: Lymecycline 408mg Patient Information Leaflet.
The most common side effects include; nausea, abdominal pain, diarrhoea and headache. Many side effects settle down after a few days or weeks. It is unusual for treatment to need to be stopped.