Acne systems containing salicylic acid or benzoyl peroxide usually suffice for mild-to-moderate cases of acne. Moderate cases will need prescription creams like tretinoin or topical antibiotics. For severe acne cases it is time to use stronger ammunition; this is where severe acne treatment with oral or systemic antibiotics come into play, especially when acne scars begin to form.
Systemic antibiotics cure acne by directly killing bacteria from within, thereby reducing inflammation. They are administered for a period of 8-12 weeks. Higher dosages are usually given initially and then lowered down as the acne improves. Over time, the bacterial resistance to the antibiotic may occur and drug starts to lose effectiveness. When this happens, another antibiotic may be given.
Antibiotics commonly given for severe acne treatment includes the following:
Tetracycline
- Tetracycline is the most commonly prescribed antibiotic for acne
- Initial dose is 500 mg twice daily until the acne significantly improves
- Dosage may then be reduced to 250mg twice daily
- Must be taken on an empty stomach to for it to be most effective. Foods, milk, and other dairy products affect absorption of this drug.
- Not recommended for pregnant women as this can affect the development of the unborn child’s bones and teeth.
- Well known brand names include Ala-Tet®, Sumycin®, Panmycin®, Robitet 500®, Brodspec®, Tetracap®, Emtet-500®, and Tetracon®
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Doxycycline
- Doxycycline, like Minocycline, it is a kind of tetracycline
- Usual dosage is 50 to 100 mg twice daily
- Causes nausea and gastrointestinal tract upset
- More likely than tetracycline to increase sensitivity to sunlight or cause sunburns (phototoxicity)
- Brand names include Adoxa®, Alodox™, Atridox™, Bio-Tab™, Doryx®, Doxal™, Doxy™, Monodox®, Oracea™, Periostat®, Vibra-Tabs®, and Vibramycin®
Minocycline
- A second-generation tetracycline derivative
- Tends to show a more rapid and sustained clinical improvement compared to tetracycline and doxycycline
- Usual dosage is 50 to 100 mg twice daily
- Bacterial resistance to minocycline is least compared to that of tetracycline and erythromycin
- In addition to the adverse affects noted with the other tetracyclines, minocyline may cause bluish-gray skin pigmentation and various autoimmune phenomena
- Should be avoided by pregnant women and those who are breastfeeding
- Well-known trade names are Dynacin®, Minocin®, Solodyn®, and Vectrin®
Erythromycin
- Typical dosage is 250 – 500 mg twice a day
- Bacterial resistance to erythromycin is more common compared to other oral antibiotics; for this reason, it is recommended less often that the tetracyclines
- May be taken together with food
- Considered safe for pregnant or breastfeeding women
- Some of the brand names are Robimycin®, E-Mycin®, Erymax®, Ery-Tab®, Eryc®, Erythrocot®, Erythroped®, Ilosone®, Zineryt®, and Abboticin®
Clindamycin
- Improves inflammatory acne
- Rarely used because it may cause a serious intestinal infection called pseudomembranous colitis caused by the bacteria Clostridium difficile
- Marketed as Cleocin®
Cotrimoxazole
- A combination of the antibiotics trimethoprim and sulfamethoxazole which work in synergy to kill bacteria
- Reported to be successful in treating severe acne as indicated in several acne forums. However, caution is advised due to possibility of severe adverse effects.
- Brand names include Septrin® and Bactrim®
If your severe acne does not respond even after full courses of several systemic antibiotics, it is time to consider severe acne treatment with Accutane (isotretinoin).
