Acne is a common skin condition which affects teenagers, although adults can also experience it. Acne can be managed with drugs purchased over the counter without a prescription, such as be benzoyl peroxide (Acnecide). Antibiotics for acne are reserved For people with mild-to-moderate acne. Antibiotics are effective in the management of acne vulgaris. This post summarises different antibiotic options for acne treatment, including most prescribed topical products (applied to the skin), including combination products with retinoids and oral antibiotics.
Antibiotics for acne: treatment recommendation
The ‘official’ guideline on acne treatment recommends the use of topical drugs to manage mild to moderate acne. Topical drugs are applied to the skin in the form of creams, gels, or lotions. Topical products for the treatment of acne may contain the following:
- retinoid alone or in combination with benzoyl peroxide
- an antibiotic. A topical antibiotic for acne should always be prescribed in conjunction with benzoyl peroxide. The addition of second active ingredient, such as benzoyl peroxide, reduces the risk of bacterial resistance, making antibiotics less effective in treating infectious conditions.
Patients who fail to respond to topical treatment may be recommended to take and additional oral antibiotics, usually for a maximum of 3 months. This means the treatment of oral antibiotics with a topical retinoid or benzoyl peroxide.
An alternative to oral antibiotics, patients may use a combined oral contraceptive (unless not suitable) such as Co-cyprindiol (Dianette®) in addition to a topical product.
Still no results?
Patients who cannot tolerate an oral antibiotic or patients who fail to see improvements within 3 months may be switched to an alternative oral antibiotic.
Patients who fail to respond to treatment with two different antibiotics may be considered for treatment with isotretinoin (NICE, 2019). Patients are usually referred to a specialist dermatologist before treatment with isotretinoin is started.
Why are antibiotics used for acne?
Acne happens when dead skin cells and sebum (an oily substance produced by hair follicles) get trapped and form a plug in the hair follicle, blocking skin pores and forming whiteheads or blackheads. One of the causes of acne is the growth of bacteria inside the blocked pores. Antibacterial drugs stop the growth of bacteria, preventing acne development.
Topical products containing antibiotics such as gels, creams, and lotions are used mainly to treat mild to moderate acne. Antibiotics applied to the skin can be used on their own or in combination with other drugs such as retinoids or benzoyl peroxide. Combination products are more effective in treating acne than products containing just antibiotics (Strauss et al 2007). Combination products are also preferred in the management of acne to reduce antibacterial resistance, making antibiotics less effective in treating the infections.
Oral antibiotics are effective for moderate to severe acne (ibid). The use of oral antibiotics for acne is usually time-limited to reduce bacterial resistance.
How to get antibiotics for acne?
In the UK, almost all antibiotics used in the management of acne treatment (topical and oral) are prescription-only medicines (POM), which means that a GP or another qualified prescriber needs to produce a prescription to allow the supply of medication to a patient.
Two main options for getting an antibiotic prescription for acne treatment include:
- Appointment with your GP
- Use of private services
Treatment of acne on NHS
The first option does not need a lot of explanations. GP can prescribe an antibiotic for acne management after the consultation with a patient.
The supply of medication on NHS prescription is free of charge for anyone aged 18 years and under and in full-time education. Patients who are 19 years or over may also be eligible for free prescriptions or apply to be exempt from paying for NHS prescription charges.
Use of private services to get antibiotic for the treatment of acne
Larger pharmacy chains such as Boots and Lloyds Pharmacy offer online private service, allowing patients to pay for the online consultation (assessment form) and supply of prescription-only medication. Patients pay for the cost of the medication regardless of their age. The cost of a prescription is usually included in the price of the product. For example:
- With Boots Acne Online Clinic, patients can choose from topical products, such as Skinoren (Azelaic acid) and Duac (Clindamycin/benzoyl peroxide).
- Lloyds Pharmacy Online Doctor offers topical treatment as well as oral antibiotics for acne treatment.
The most prescribed topical products for acne
The table below lists the most prescribed topical antibiotics for acne:
|Duac Once Daily Gel 1% & 5%||1% of clindamycin & 5% benzoyl peroxide|
|2.||Duac Once Daily Gel 1% & 3%||1% of clindamycin & 3% benzoyl peroxide|
|Erythromycin and zinc acetate|
|Clindamycin (1%) and tretinoin (0.025%)|
Erythromycin and tretinoin
* Items prescribed in the UK. Prescribing period: Apr ’19—Mar ’20. OpenPrescribing.net, EBM DataLab, University of Oxford, 2017
The most-prescribed oral antibiotics for acne
It is more difficult to deduce which oral antibiotic for acne is the most popular as prescribing information is not solely available in acne treatment but also for a variety of conditions. Antibiotics such as erythromycin and doxycycline are commonly used for the treatment of different infections.
Antibiotics for acne
Topical products for acne
Duac Once Daily Gel
Duac Once Daily Gel is the most popular topical preparation containing clindamycin (an antibiotic) and benzoyl peroxide. Duac Once Daily Gel is a prescription-only medication.
Duac Once Daily Gel comes in two different formulations:
- Duac Once Daily Gel 1% & 3% (1% of clindamycin and 3% benzoyl peroxide)
- Duac Once Daily Gel 1% & 5% (1% of clindamycin and 5% benzoyl peroxide)
Both preparations of Duac Once Daily Gel are licensed for the management of acne in adults and children over 12 years of age, especially when inflammatory lesions are present.
Treatment with Duac Once Daily Gel is usually limited to a maximum of 12 weeks. Treatment with Duac Once Daily Gel was summarised in the separate post: 15 Facts You Must Know About Duac Once Daily Gel.
Zineryt lotion is a combination product containing an antibiotic – erythromycin and zinc acetate. There is no specific age restriction in the use of Zineryt lotion in the management of acne. Zineryt lotion can be used by children, adults, and the elderly.
Zineryt lotion is usually applied twice a day with treatment limited to 10-12 weeks.
Zineryt lotion: possible side effects
Zineryt lotion is well tolerated. Rarely patients may experience temporary stinging or slight redness of the skin.
For more information please refer to the product information leaflet.
Dalacin T® lotion
Dalacin T lotion contains one main active ingredient, an antibiotic, clindamycin. Dalacin T lotion is licensed in the management of acne vulgaris with no specific age restrictions.
Dalacin T is usually applied twice daily; however, follow your doctor’s directions on the use of the lotion.
Dalacin T® lotion: possible side effects
Patients who use Dalacin T may experience some side effects. Common side effects associated with the use of Dalacin T:
- Skin irritation
- Skin dryness
- Oily skin
Treclin is another prescription-only gel for acne treatment in adults and children over 12 years of age. Treatment with Treclin gel is limited to a recommended maximum of 12 weeks of treatment.
Treclin gel contains two ingredients clindamycin (1%) and tretinoin (0.025%).
Treclin is one of two combination products available on prescription which contain tretinoin.
Tretinoin has anti-inflammatory and anti-comedolytic properties, preventing the formation of acne papules such as blackheads and whiteheads, which cause the formation of spots. Tretinoin also promotes the peeling off the dead cells, which form on the surface of the skin. An antibiotic, clindamycin, kills the bacteria, which contributes to acne symptoms and reduces the inflammation fo the skin.
Treclin gel is applied once daily at night. Please refer to the product information leaflet for specific instruction on the application of Treclin gel and special warning and precautions on the use.
Treclin Gel: possible side effects
Uncommon side effects associated with the use of Treclin gel include:
- dry and redness of the skin
- increased production of sebum
- photosensitivity reactions, sunburn
- itching, rash, scaling of the skin, sunburn
- local side effects at the site of application such as burning, inflamed skin, dryness, redness of the skin
Aknemycin Plus is the second topical product for acne management, which contains tretinoin and additionally and antibiotic – erythromycin. The mechanism of action is the same as discussed in the previous paragraph.
Aknemycin Plus can be used once or twice daily with recommended treatment duration of 9-12 weeks.
Aknemycin Plus: side effects
Aknymycin Plus is generally well tolerated. At the beginning of the treatment, patients may think that skin condition is getting worse, however this should pass quickly.
Aknemycin Plus other warnings
Photosensitivity may happen during treatment with Aknemycin Plus. Patients should avoid direct sunlight, sun lamps or sunbeds when treated with Aknemycin Plus.
Oral antibiotics for acne
As it was mentioned before, oral antibiotics are recommended for moderate acne treatment in patients who fail to respond to topical therapy. Oral antibiotics are usually prescribed for a maximum period of 3 months.
Tetracycline oral antibiotics are mainly used in the management of acne. Most commonly used tetracyclines include:
Erythromycin (a macrolide antibiotic) can also be used; however, it should be usually avoided due to the high level of resistance of acne-causing bacteria, which makes the treatment less effective. Antibiotic resistance described the decreased effectiveness of antibiotics to treat a bacterial infection.
In contrast to topical preparations for acne (gels, creams, and lotions), oral antibiotics are associated with a possible range of side effects.
Lymecycline for acne treatment
Lymecycline (brand name: Tetralysal) is one of the most popular oral antibiotic for the treatment of ace. Lymecycline comes in the form of capsules. Each capsule contains 408mg of lymecycline.
In acne management, one capsule is taken daily (dose for adults and children over 12 years of age) with a recommended treatment duration of a minimum of 8 weeks (eMC, 2020).
Lymecycline: common side effects
The most common side effects associated with the use of lymecycline include:
- gastrointestinal side effects including nausea, abdominal pain, diarrhoea
- nervous system side effects including a headache
Other important information for lymecycline
- Children under 8 years should not use lymecycline due to possible permanent staining of teeth.
- Lymecycline should be taken with plenty of water to avoid possible irritation and ulceration of the oesophagus.
- Patients taking lymecycline should avoid direct sunlight due to the possible photosensitivity of the skin to the sunlight.
For more information, read the product information leaflet.
Doxycycline for acne
Doxycycline is another tetracycline type of antibiotic used in the management of various infections and treatment of acne.
Doxycycline comes in the form of capsules (50mg and 100mg). The recommended daily dose of doxycycline for acne in adults and children over 12 years of age is 100mg once daily.
Doxycycline: common side effects
Some common side effects which may be experienced by patients taking doxycycline include:
- Angioedema (swelling on the face)
For more information on side effects, please refer to the product information leaflet.
Similarly to lymecycline, doxycycline should not be used in children under the age of 8 due to possible permanent staining of the teeth.
Photosensitivity reactions are also possible; therefore, patients should avoid direct sunlight or sun lamps.
Oxytetracycline for acne
Oxytetracycline is less commonly prescribed in the community. Like other tetracyclines, oxytetracycline can be used to treat acne in adults and children over 12 years of age, and when antibiotic treatment is considered necessary.
Oxytetracycline requires more frequent administration as compared with antibiotics discussed so far. Oxytetracycline tablets are usually taken four times a day. Additionally, it is recommended to take oxytetracycline on an empty stomach.
Tetracycline and minocycline
Despite belonging to the same type of antibiotic class as doxycycline or lymecycline, tetracycline and minocycline are rarely prescribed in the community and will be excluded from the discussion.
eMC (2020). SmPC: Tetralysal 300mg Hard Capsules. Available at: https://www.medicines.org.uk/emc/product/926 Accessed on 27/05/2020
NICE (2019). Acne vulgaris. Available at: https://cks.nice.org.uk/acne-vulgaris#!scenarioRecommendation Accessed on 30/05/2020
OpenPrescribing.net, EBM DataLab, University of Oxford, 2017 Available at: https://openprescribing.net/ Accessed on 20/05/2020
Strauss JS, Krowchuk DP, Leyden JJ, American Academy of Dermatology/American Academy of Dermatology Association, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007;56(4):651–663 Available at: https://doi.org/10.1016/j.jaad.2006.08.048 Accessed on 30/05/2020