Antibiotics for Acne
Oral and topical Antibiotics can be used to treat acne but they should not be used for long.
Bacteria are one of the known causes of acne. They make one part of the debris (along with sebum and dead skin cells) that clog skin pores to cause acne breakouts.
Not all bacteria cause acne. In fact, only a few are known to cause this skin disease. Of these, the most popular is Propionibacterium acnes.
Like most bacteria, there are different strains of Propionibacterium acnes. Some strains of this bacterium are known to promote good skin health. However, other strains are associated with long-term acne problems.
When Propionibacterium acnes and another bacterium called Staphylococcus epidermis are both present on the skin, acne almost always results.
These bacteria can carry on a cycle of acne breakouts that lasts long into adulthood. Therefore, they are implicated in most forms of acne including acne vulgaris and adult acne.
Since both the healthy and harmful strains of Propionibacterium acnes can be found on the skin, it is still undecided whether the bacterium evolves to the harmful strain because of prevailing conditions or is acquired as an infection.
Bacteria that cause acne can change the nature of the skin itself by increasing sebum production, interfering with the rate of keratinization and promoting repeated inflammatory reactions.
Therefore, bacterial infection is a major contributor to the formation of acne lesions such as whiteheads, blackheads, pustules and papules as well as other acne symptoms like seborrhea, nodules, cysts and scars.
Oral antibiotics and topical antibacterial agents are both effective in the treatment of acne.
Treatment with oral antibiotic is usually started with a large dose to quickly bring the population of the colonizing bacteria down. Only when the acne is well controlled should the dose of the antibiotic be reduced.
While oral antibiotics are intended for the treatment of moderate to severe acne, topical antibiotics are used to treat mild to moderate acne. They are seldom used solely but are found in acne products combined with other active ingredients.
Some of the most effective antibiotics used in acne treatment are discussed below.
Tetracycline is a broad-spectrum antibiotic. It is a widely prescribed antibiotic because it is effective against a wide number of bacteria. It selectively targets bacteria cells while sparing host cells.
Care should be taken when using tetracycline as it can cause skin photosensitivity. It should not be given to pre-adolescent children and pregnant women because it stains developing teeth even before they appear.
Doxycycline and Minocycline are also members of the tetracycline group. They are also broad-spectrum antibiotics.
Doxycycline is used to treat acne in people who cannot tolerate or who do not respond to erythromycin and tetracycline. However, it can also cause photosensitivity skin reactions (even more than tetracycline) especially when used for long-term treatment.
Minocycline is especially indicated for treating pustular acne (acne with lots of pimples). Long-term treatment with minocycline can also cause teeth discoloration and skin pigmentation.
The recommended starting dose of tetracycline in acne treatment is 500 mg taken twice daily. Once the acne lesions are well controlled, the dose should be reduced to 250 mg twice daily. From there, the drug can be discontinued when the acne lesions are cleared off.
50 – 100 mg taken twice daily is the recommended dose for minocycline and doxycycline in acne treatment.
Other tetracycline derivatives used for treating acne are oxytetracycline and lymecycline.
Erythromycin is also a broad-spectrum antibiotic. It is available in different dosage forms including capsules, coated tablets, gels, ointments, eye drops, oral suspensions and injections.
It inhibits bacterial growth instead of killing them off. In this way, it reduces their population long enough for them to die out. Therefore, erythromycin is most effective in acne treatment when the population of the colonizing bacteria is still low.
The recommended dose of this drug is 250 – 500 mg taken twice daily. It is also available in topical acne products.
Erythromycin may cause dry skin, irritation and other symptoms of allergic reaction in some people. It can also cause gastrointestinal upset.
Clindamycin is used for treating infections caused by anaerobic bacteria such as Propionibacterium acnes.
It is the most popular topical antibiotic used in the treatment of acne. When formulated as Clindamycin phosphate, it is used to treat mild to moderate acne.
Different studies have shown that the combination of clindamycin with other anti-acne drugs produces more effective acne solutions than single therapy with each of the drugs. Such synergistic antibiotic effect is observed when clindamycin is combined with benzoyl peroxide or adapalene.
Clindamycin is also known to be particularly effective in combating drug-resistance bacteria such as MRSA (methicillin-resistant Staphylococcus aureus).
It can also be taken as an oral antibiotic in the following dose: 75 – 150 mg twice a day. The major side effect of oral administration of clindamycin is a type of diarrhea caused by the opportunistic infection by Clostridium difficile.
Since acne treatment may last for years, antibiotics are only recommended for short-term therapy. There are two reasons for this.
First, antibiotics should only be taken for short periods because long-term therapies increase the chance of the causative bacteria developing resistance to effective antibiotics.
Secondly, antibiotics can have very serious side effects which only worsen with long-term therapy due to their cumulative effects.
Antibiotic treatment of acne should only last for a few months at most. Thereafter, topical antibacterial agents such as benzoyl peroxide or topical retinoids should be used as maintenance treatment.
Resistance sometimes develops to the antibiotics used in acne treatment. This is evident from reports of acne sufferers who no longer see any improvement with antibiotic therapy.
Antibiotic resistance happens because of mutations in the bacteria responsible for acne. This can be caused by indiscriminate use of antibiotics for acne treatment. Antibiotic resistance can occur to both oral and topical antibiotics.
A large-scale study published in the British Journal of Dermatology found that more than half of the over 4000 acne patients who participated had antibiotic-resistant bacteria colonizing their skins.
This high incidence of resistant bacteria is not confined only to those who use antibiotics alone. Acne patients who had never taken antibiotics for their skin condition also had these resistant bacteria.
Apart from genetic mutation of acne-causing bacteria, the resistance to topical antibiotics can happen when these microbes produce a thin, resistive film on the skin. This forms a barrier against the penetration of antibiotic medication.
Antibiotic-resistant acne is treated with a combination of antibiotics or by combining an antibiotic with other anti-acne agents especially retinoids and benzoyl peroxide.
One study found that combining benzoyl peroxide with antibiotics resulted in 99.9% effectiveness against both resistant and non-resistant bacteria.
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