Skin Health Acne Treatment Antibiotics Used to Treat Acne By Heather L. Brannon, MD Heather L. Brannon, MD Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years. Learn about our editorial process Updated on May 17, 2020 Medically reviewed by Casey Gallagher, MD Medically reviewed by Casey Gallagher, MD on September 22, 2019 Casey Gallagher, MD, is board-certified in dermatology. He is a clinical professor at the University of Colorado in Denver, and co-founder and practicing dermatologist at the Boulder Valley Center for Dermatology in Colorado. Learn about our Medical Review Board Print Table of Contents View All Table of Contents How They Work Types Side Effects Antibiotic Resistance A Word From Verywell Antibiotics are frequently used to treat acne since they help decrease the number of bacteria in and around the pilosebaceous unit, consisting of a hair follicle, sebaceous gland, and a hair. Acne is caused by the effects of hormones on this unit. Specifically, the follicle becomes obstructed and an overgrowth of normal skin bacteria, Propionibacterium acnes, causes the destruction of the lining of the follicle. This process allows the follicular material to enter the dermis, causing an inflammatory response. Bunlue Nantaprom / EyeEm/Getty Images How They Work Antibiotics work by several mechanisms. The most important mechanism is the decrease in the number of bacteria in and around the follicle. Antibiotics also work by reducing the irritating chemicals produced by white blood cells. Finally, antibiotics reduce the concentration of free fatty acids in the sebum, also reducing the inflammatory response. Types The most frequently used antibiotics for acne are summarized here. Tetracycline Tetracyclines are the most widely prescribed class of antibiotic for acne. There are several antibiotics within the class, including tetracycline, in both 500-milligram (mg) and 250-mg formulations. The usual starting dose is 500 mg twice a day continued until a significant decrease in acne lesions is seen. The dose can then be decreased to 250 mg twice a day or discontinued. Tetracycline should not be given to people who are pregnant or children under 9 years of age. Tetracycline must be taken on an empty stomach to be the most effective. For a teenage boy who eats frequently, this can be difficult. Tetracycline Treatment of Acne Erythromycin Erythromycin is a very commonly used antibiotic for acne. It has anti-inflammatory properties that help reduce redness in lesions in addition to killing bacteria. The dosage of erythromycin varies with the type used, but it is typically prescribed as 250 to 500 mg twice a day. Erythromycin is preferred over tetracycline for people who are pregnant and for children under age 8. Erythromycin should be taken with food as it can cause stomach upset and nausea. Erythromycin is sold under the names: Ilotycin, Ery-Ped, Ery-tab, Staticin, Erythra-Derm, Akne-mycin, Pce, Eryc, Ery, Eryped, T-Stat, Erygel, and E.E.S. How Oral Erythromycin Works for Acne Minocycline Minocin (minocycline) is a tetracycline derivative that has been used effectively for decades as a treatment for acne. It is especially useful for pustular type acne. A pustule is a pus-containing vesicle such as a whitehead surrounded by redness. While the absorption of minocycline is decreased with food, it is not as significant as the decrease seen with tetracycline. The usual starting dose is 50 to 100 mg twice a day. Major side effects of minocycline include dizziness, nausea, vomiting, skin pigmentation changes, and tooth discoloration. The skin and tooth changes are seen more often in people who have taken minocycline for a long time. Minocycline (and theoretically any tetracycline derivative) should be avoided in those who are using Accutane (isotretinoin) as the combination of these may result in a condition in which there is increased pressure within the skull (pseudotumor cerebri). Treating Acne With Oral Minocycline Doxycycline Doxycycline is often used for people who do not respond to or cannot tolerate erythromycin or tetracycline, or for those who will likely have difficulty with the "no food" guidelines of tetracycline (such as teenage boys.) The dosage of doxycycline is started at 50 to 100 mg twice a day. It should be taken with food; otherwise, it can cause significant nausea. Doxycycline is more likely than tetracycline to increase sensitivity to the sun or cause sunburns, a phenomenon known as photosensitivity. There are other acne medications that may cause photosensitivity as well, such as benzoyl peroxide, alpha-hydroxy acids, and topical retinoids. Doxycycline is available under these brand names: Doryx, Oracea, Monodox, Atridox, Morgidox, Vibra-Tabs, Alodox, Ocudox, Doxy, Acticlate, and Vibramycin. Treating Acne With Doxycycline Septra/Bactrim and Macrolides Septra or Bactrim (sulfamethoxazole/trimethoprim) and Zithromax (azithromycin) a macrolide, have often been used to treat moderate to severe inflammatory acne. Studies do not seem to favor one antibiotic over another with this condition, but treatment appears to work much better when combined with topical therapy. Allergic reactions (sulfa allergy) are fairly common with sulfanomides, and significant resistance has been seen with both of these categories of antibiotics. Topical Antibiotics Clindamycin is very useful as an oral antibiotic for acne, but it is most widely prescribed as a topical antibiotic. The starting dose is 75 to 150 mg twice a day. The major side effect of clindamycin therapy is a serious intestinal infection called pseudomembranous colitis caused by the bacteria, Clostridium difficile. A Clostridium difficile infection is much more common with oral clindamycin but has been reported with the topical product as well. Topical clindamycin is available as Cleocin-T, Clinda-Derm, Clindagel, Clindets, C/T/S, and Evoclin. Acne Treatment With Topical Clindamycin Side Effects All antibiotics can cause vaginal yeast infections in women. Tetracycline seems to be the antibiotic that most frequently has this side effect. All oral antibiotics can also lessen the effectiveness of birth control pills, so those who are taking these antibiotics should use a backup birth control method. Nausea is fairly common with erythromycin and doxycycline. It's important to talk to your dermatologist about any potential side effects as well as when you should call with any symptoms. Antibiotic Resistance In recent years we have been seeing increasing resistance of the bacteria Propionibacterium acnes against the oral antibiotics used. Current strategies to reduce resistance (and hence, the lack of an effect of the antibiotics upon acne) recommend using antibiotics in combination with topical treatments and limiting the duration of use when possible. A Word From Verywell Antibiotics can be very helpful for some people with acne and work by a combination of mechanisms. Some antibiotics work better for particular types of acne and your dermatologist can make the best choice by understanding your history of acne as well as your lifestyle. As with any medications, side effects may occur. Fortunately, there are several different choices available if one of the above is not helpful. Antibiotics are usually used in combination with topical treatments and good daily skin care for acne-prone skin. Get Clearer Skin With These Simple Care Tips Was this page helpful? Thanks for your feedback! Dealing with acne can be frustrating. Our free guide provides expert tips to help you take control. Sign up and get yours today. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 12 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-73.e33. doi:10.1016/j.jaad.2015.12.037 Leyden JJ, Del Rosso JQ. Oral antibiotic therapy for acne vulgaris: Pharmacokinetic and pharmacodynamic perspectives. J Clin Aesthet Dermatol. 2011;4(2):40‐47. Jain A, Sangal L, Basal E, Kaushal GP, Agarwal SK. Anti-inflammatory effects of erythromycin and tetracycline on Propionibacterium acnes induced production of chemotactic factors and reactive oxygen species by human neutrophils. Dermatol Online J. 2002;8(2):2. American Academy of Dermatology. Acne clinical guideline. Maffeis L, Veraldi S. Minocycline in the treatment of acne: latest findings. G Ital Dermatol Venereol. 2010 Jun;145(3):425-9. Layton A. The use of isotretinoin in acne. Dermatoendocrinol. 2009;1(3):162–169. doi:10.4161/derm.1.3.9364 Goetze S, Hiernickel C, Elsner P. Phototoxicity of doxycycline: A systematic review on clinical manifestations, frequency, cofactors, and prevention. Skin Pharmacol Physiol. 2017;30(2):76-80. doi:10.1159/000458761 Bienenfeld, A., Nagler, A., and S. Orlow. Oral antibacterial therapy for acne vulgaris: An evidence-based review. American Journal of Clinical Dermatology. 2017 Aug;18(4):469-490. doi:10.1007/s40257-017-0267-z Tan CB, Rajan D, Shah M, et al. Toxic megacolon from fulminant Clostridium difficile infection induced by topical silver sulphadiazine. BMJ Case Rep. 2012;2012:bcr2012006460. doi:10.1136/bcr-2012-006460 Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Crit Rev Microbiol. 2016;42(6):905-27. doi:10.3109/1040841X.2015.1091805 Tan AU, Schlosser BJ, Paller AS. A review of diagnosis and treatment of acne in adult female patients. Int J Womens Dermatol. 2017;4(2):56–71. doi:10.1016/j.ijwd.2017.10.006 Adler B, Kommehl H, Armstrong A. Antibiotic resistance in acne treatment. JAMA Dermatology. 2017;153(8):810-811. doi:10.1001/jamadermatol.2017.1297 Additional Reading Weller, Richard P. J. B., Hamish J.A. Hunter, and Margaret W. Mann. Clinical Dermatology. Chichester (West Sussex): John Wiley & Sons Inc., 2015. Print.