Oral Antibiotics

imagetempalte_6Why are oral antibiotics used for acne?

Oral antibiotics come in handy in two ways when it comes to acne treatment.

  • They kill the bacteria deep in your follicles that are causing bacteria in the first place.
  • They decrease inflammation. This is one of the things antibiotics do best. The acne inflammation we encounter—red, raised pimples that are tender to the touch—is annoying enough, but there’s often even more going on below the surface. Dermatologists will generally recommend doxycycline or minocycline, both just as good at reducing inflammation as they are at getting rid of that sniffle.

Why would I be prescribed an antibiotic?

Antibiotics are prescribed as a second defense when creams don’t work, or if the acne is widespread which can make it difficult to use a cream. They’re also only used for those annoying red, tender pimples. They unfortunately don’t do much harm to blackheads.  Your dose depends on the severity of your acne, but it’s normally going to be around 100-200 mg a day.

How do I take them?

  • Doxycycline:
    • Doxycycline is tricky. It does it’s best work when you take it on an empty stomach, but it also has a tendency to make you feel like you might throw up (fun, we know). The best plan of action is to try to take them on an empty stomach, but if you can’t tolerate that, do it after a meal.
    • Another pro tip: whether you take it with food or not, definitely don’t take doxycycline with calciums or antacids. Both will bind to it and shoot straight through your body without getting used! (Again. Fun. We know). So a meal is fine, but it should be low in dairy products. Milk in coffee, tea, or sparingly in cereal is OK, but lay off the four-cheese milkshake for now.
    • Not before bed! The pill can agitate your throat and give you heartburn or even an ulcer. Make sure you take it at least 30 minutes before lying down (that means naps too!) and wash it down with a big glass of water.
  • Minocycline:
    • No rules. Just take it.

How soon will they work?

While antibiotics may have wiped out your strep or ear infection in a week, they’re gonna take a bit longer for acne. Expect to see results in 3-4 weeks, but know that you’ll have to be on them for a few months to get the full effect.

Common side effects

As mentioned before, Doxycycline can make you feel queasy, especially if you take it first thing in the morning. If your dosage is high (200mg a day), it can increase your sun sensitivity, so make sure to really lather on the sun screen when catching rays.

Minocycline won’t cause sun sensitivity and is less likely to cause an upset stomach, but when it does, it’s often made worse by a headache and dizziness. If this happens, try taking it with food later in the day. Also, steer clear of the generic versions if you think you have a weak stomach as they’re more likely to cause it.

While not extremely likely, Minocycline allergic reactions are much more likely than for Doxycycline, and if you notice any itchiness or hives, stop the drug and consult your dermatologist.

Finally, very rarely Minocycline causes dark spots on the lower legs or in the bottom of acne scars on your face. It’s worth noting that this generally happens late in a treatment, so some patients might mistake it for a separate cause.

Some words about antibiotic resistance

Whenever an antibiotic is taken, the bugs it targets start to develop resistance to the antibiotic by mutating to avoid being killed. The speed and intensity with which the bug mutates depends on the antibiotic used and the hardiness of the bug.

Minocycline, and to a lesser extent doxycycline are less likely than most antibiotics to cause this problem, but it still happens from time to time. In both these cases, the weaker bugs are killed off first leaving the stronger ones behind.  This can eventually cause the production of superbugs that are very hard to kill. While this makes an awesome Sci-Fi movie, it makes a not-so-awesome you. The spreading of the bugs hurts you, hurts you acne, and can hurt the people around you because you may get them sick!

That being said, there are a few things your dermatologist will do to ensure this doesn’t happen.  First of all, they do their best to use antibiotic treatment as sparingly as possible. And when they do need to use it, they keep it short. Also, though they aren’t sure why, combining the antibiotics with benzoyl peroxide greatly hampers the development of resistant bugs.

A couple more pro tips!

  •    Take your antibiotics consistently. The best way to cause the development of resistant bugs is to skip doses or to go on-off-on-off of them.
  • Take everything else consistently!  Even if the topical medications you are prescribed along with your oral antibiotics don’t seem to be as effective as the antibiotics, don’t stop them!   They will be your savior when the antibiotics are stopped.

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