Oral antibiotics work by removing the p.acne bacteria and decreasing inflammation. However there is a big challenge today in using modern antibiotic – that is, over-prescription of antibiotic. The result is a growing resistance to these drugs which means that diseases that once could have been wiped out with a course of antibiotics may now have dire potential.

We are not suggesting not to use antibiotics. In fact, they should be used as long as they are prescribed for the right reason. For example, antibiotic should be used on patients with moderate to severe acne. Two of antibiotic that we feel are safe and effective are doxycycline and minocycline. They are easily absorbed form of tetracycline which has been used for decades to reduce acne inflammation. Tetracycline has very few side effects however there is an emerging resistance to this drug.

Another effective antibiotic for patient with moderate to severe acne is erythromyclin. Unfortunately it has been overly prescribed which resulted in 50 percent of the people are resistance to it. Still erythromycin and eteracycline are very useful because of their anti-inflammatory potential. Other oral antibiotics include sulfa drugs such as Bactrim and Septra. They are effective orally but can cause worrisome reactions such as skin allergies and bone marrow suppression.

Clindamycin taken orally has been use for over forty years and is a second-line antibiotic, prescribed when the tetracyclines or erythromycin medications fail. The most significant, though rare adverse reaction associated with clindamycin is pseudomembranous colitis, which is a bloody diarrhea that required treatment by a gastroenterologist.

When prescribing antibiotics to patient, it is important that the dermatologist set a timetable to its use. The average course of antibiotic treatment is about one to six months.

After the end of the course, the dermatologist should schedule an appointment with the patient to assess the acne condition. If the condition improves and there is no side effect, the treatment is to be continued until the skin is clear. Usually topical medication is to be used concurrently and some time Differin or Retin-A is prescribed to aid in further improvement or addresses other problem such as post-inflammatory pigmentation.

A second appointment is to be arranged with the patient after six to either weeks into the treatment. If the acne condition improves, then the dermatologist is likely to lower to stop the oral antibiotic dose and just continue with the topical treatment.

There is no miracle antibiotic cure for acne. Just like you don’t get acne over night, neither will it goes away over night. Sometime if the condition does not improve with the use of one type of antibiotic, another type may have to be prescribed.

For female patients, they can use birth control pills and spironolactone (Aldactone) for acne treatment. However if the condition does not improve and the acne is severe enough and likely to create scar, then the dermatologist may even issue Accutane as the next remedies. In our opinion, it is better to have five months of Accutane treatment than months or years on antibiotic that does not help in solving the acne problem.