Oral Antibiotics for Acne
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REVIEW ARTICLE
Oral Antibiotics for Acne Dillon J. Patel1 · Neal Bhatia2
© Springer Nature Switzerland AG 2020
Abstract Oral antibiotics are integral for treating inflammatory acne based on what is understood about the pathogenesis as well as the role of Cutibacterium acnes. However, rising concerns of antibiotic resistance and the perception of “antibiotic phobia” create potential limitations on their integration in an acne treatment regimen. When prescribing oral antibiotics, dermatologists need to consider dosage, duration, and frequency, and to avoid their use as monotherapy. These considerations are important, along with the use of newer strategies and compounds, to reduce adverse-event profiles, antibiotic resistance, and to optimize outcomes. Aside from concomitant medications, allergies, and disease severity, costs and patient demographics can influence variability in prescribing plans. There are multiple published guidelines and consensus statements for the USA and Europe to promote safe antibiotic use by dermatologists. However, there is a lack of head-to-head studies and evidence for comparative superiority of any individual antibiotic, as well as any evidence to support the use of agents other than tetracyclines. Although oral antibiotics are one of the main options for moderate to severe acne, non-antibiotic therapy such as isotretinoin and hormonal therapies should be considered. As newer therapies and more outcomes data emerge, so will improved management of antibiotic therapy to foster patient safety. Key Points Oral antibiotics play a significant role in treatment algorithms for acne vulgaris, but initiating their courses should be used in conjunction with current medical recommendations, taking the safety profile and antibiotic resistance into account. Although second-line oral antibiotics have limited data supporting usage, anecdotal clinical studies have been conducted and these agents should be considered along with non-antibiotic therapies whenever possible as well as initiating isotretinoin where indicated. Patient preferences and concerns for global antibiotic resistance have created improved conversations between patients and dermatologists for exploring the options for starting, stopping, and reconsidering courses of oral antibiotics. * Neal Bhatia [email protected] 1
Biochemistry and Cell Biology, University of California San Diego, La Jolla, USA
Therapeutics Clinical Research, 9025 Balboa Avenue, San Diego, CA 92123, USA
2
1 Introduction Globally, acne mainly affects ~ 85% of individuals from the ages of 12–25 years, and greater than 40% of men and women reported that they experienced acne in their 20s and greater than 20% in their 30s [1, 2]. When it comes to prescribing antibiotics for acne, it seems everyone is now an expert. Antibiotic safety and antibiotic resistance are understandably of concern to both prescribers and patients. However, antibiotics are often labeled as unsafe by patients before they arrive at the dermatologist’s office. Despite the age of ant
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