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A Guide to Oral Antibiotics


Sometimes we can think that the insides and outsides of our bodies are two totally different worlds, but this isn’t the case. Our skin is our body’s largest organ, and it performs many functions to keep us healthy: it regulates our temperature, allows us to touch the world around us, and basically acts like a barrier between our delicate insides and the harsh outside world1.


So when our skin becomes inflamed, it makes sense that we treat it like we’d treat any other part of our bodies—and antibiotics are one highly effective treatment option we can consider for acne-prone, inflamed skin.

What do antibiotics do for skin?

Antibiotics have two specific functions in clearing up acne: they reduce inflammation and control bacteria.


Inflammation

Anyone who has had acne will be familiar with the inflammation that comes along with it. It can be painful, and can leave red marks and swelling that last even after the pimple itself has healed. There are two schools of thought around why this inflammation occurs: the first suggests that a bacteria called propionibacterium acnes breeds in the serum inside our hair follicles, and this excess of bacteria and sebum causes a pimple, which provokes an immune response from our bodies that includes swelling2,3.


The second—and newer—school suggests that inflammation actually starts long before a pimple is even formed. This school of thought suggests that acne is an inflammatory condition and should be treated as such, with anti-inflammatory medications used to clear up pimples and acne lesions4.


While these theories put forward different ideas as to how and why pimples are formed, what they have in common is that they both acknowledge that inflammation is a big part of acne. 


There are several different kinds of antibiotics that treat inflammation in different ways5: some inhibit the production of molecules that signal inflammation, and others inhibit overactive enzymes that can attack the hair follicle and sebaceous gland6. Your doctor or dermatologist will be able to prescribe the right antibiotic for your skin, and they’ll do so by taking into account the inflammation that your acne causes.


Bacteria

The propionibacterium acnes bacteria that can contribute to acne is actually present on our face all the time, even when we have no active pimples or acne lesions. As this bacteria is a part of our normal healthy skin bacteria, antibiotics that clear up acne work to control this bacteria rather than kill it completely. Some newer studies even suggest that it’s not necessary for antibiotics to target p. acnes at all6.


This is because over time, p. acnes—like many bacteria—can become resistant to antibiotics7. While oral antibiotics are less likely to induce bacterial resistance than topical antibiotics8, bacterial resistance is still something that some doctors and dermatologists are concerned about. This doesn’t mean that oral antibiotics will never work against acne, but it does mean that there are a few things you may have to do to ensure your antibiotics have the best chance of working:


  • Use antibiotics alongside a topical treatment. Antibiotics are not capable of tackling everything that causes acne, like excess sebum production or follicular keratinization, so it’s important to use them alongside something that can treat these mechanisms. Benzoyl peroxide is commonly recommended for use alongside antibiotics, and it has actually been shown to reduce the prevalence of antibacterial resistance in p. acnes8,9. Topical retinoids, niacinamide, and azelaic acid can also be used alongside antibiotics.
  • Use antibiotics for a short period of time. Long-term use of antibiotics is not recommended due to the chance of bacterial resistance10. Most doctors and dermatologists will aim to prescribe antibiotics for as short a time as possible, which may be a few months11. This allows the antibiotics enough time to do their work, while avoiding the chance of bacterial resistance.


Who are they right for?

Your doctor or dermatologist will be able to confirm if oral antibiotics are right for you. Generally they are used for more severe cases of acne, or cases where the acne has spread across areas of the body that would be impractical or inconvenient to apply a topical treatment to.


Not all antibiotics are safe for pregnant women to take, so if you are pregnant—or plan to be—you should let your doctor know before beginning a course of antibiotics12.


Are there any side effects?

Oral antibiotics do occasionally come with some side effects. They can sometimes cause slight nausea, diarrhea, and thrush. If you experience headaches or any signs of an allergic reaction, you should stop using the antibiotics and see a doctor13.


You should also be aware that some antibiotics can cause increased sensitivity to the sun13, not just on your face but across your entire body. If you’re not already using a sunscreen, now’s the time to start—use a non-comedogenic and hypo-allergenic one, which will prevent clogged pores and allergic reactions on the skin. Make sure your sunscreen provides SPF30+ coverage as well.


It’s important to know that different antibiotics can cause different side effects, so if one antibiotic is not right for you because of its potential side effects then your doctor may be able to prescribe another14.


How do I use them?

Your doctor or dermatologist will be able to advise you how many tablets to take, and when. If you start to see your acne clearing up before the course of antibiotics is over, you shouldn’t stop taking them—continue taking them as prescribed until they’re finished. 


You also shouldn’t take more antibiotics more often in the hope it will clear acne quicker, as this may cause side effects. Only ever take medication according to the directions given by your doctor.

What can I expect?

When using antibiotics with a topical skin treatment, you can expect to see a reduction in acne inflammation within 6 to 12 weeks13. If your acne has not begun to clear by this stage, you may consider seeing your doctor again for a different antibiotic, or different treatment method.


Long-term usage

Because of the potential for antibacterial resistance, antibiotics are not suitable for long-term use. Antibiotics provide your body with a ‘head start’ at fighting inflammation and bacteria, and topical treatments will continue this work as you use them over time. 


It’s important to continue using topical treatments after acne has begun to fade, and to incorporate them into a skincare routine that you can follow every day.


We recommend starting with a non-comedogenic, hypo-allergenic cleanser and toner, then using your prescribed topical treatments. Top this off with a moisturiser: a heavier cream or lotion will suit dry skin, while a lighter gel or serum will suit oilier skin. You should then continue using your SPF30+ sunscreen.


Have a read of our guides to topical treatments, like Tretinoin, Niacinamide, and Azelaic Acid.

References

  1. McDonald, Cara 2018, ‘The skin is a very important (and our largest) organ: what does it do?’, The Conversation, <https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515>, accessed 23rd June 2020.
  2. Health Direct, Acne, <https://www.healthdirect.gov.au/acne>, accessed 4th June 2020.
  3. British Association of Dermatologists 2007, Acne, brochure, British Association of Dermatologists.
  4. Tanghetti, Emil A. 2013, ‘The role of inflammation in the pathology of acne’, The Journal of Clinical and Aesthetic Dermatology, vol. 6, no. 9, pp. 27—35. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780801/>, accessed 23rd June 2020.
  5. Pradhan, Swetalina, Madke, bhushan, Kabra, Poonam, and Singh, Adarsh Lata 2016, ‘Anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology’, Indian Journal of Dermatology, vol. 61, no. 5, pp. 469—481. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029230/>, accessed 23rd June 2020.
  6. Friedman, Adam 2016, ‘Acne treatment: antibiotics don’t need to kill bacteria to clear up your skin’, The Conversation, <https://theconversation.com/acne-treatment-antibiotics-dont-need-to-kill-bacteria-to-clear-up-your-skin-56188>, accessed 23rd June 2020.
  7. Walsh, Timothy R., Efthimiou, John, Dréno, Brigitte 2016, ‘Systematic review of antibiotic resistance in acne: an increasing topical and oral threat’, The Lancet, vol. 16, no. 3, pp. 23—33. <https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)00527-7/fulltext>, accessed 23rd June 2020.
  8. DermNet NZ, Antibiotics for acne, <https://dermnetnz.org/topics/antibiotics-for-acne/>, accessed 22nd June 2020.
  9. Mayo Clinic, Acne, <https://www.mayoclinic.org/diseases-conditions/acne/diagnosis-treatment/drc-20368048>, accessed 23rd of June 2020.
  10. Tan, Audrey W. and Tan, Hiok-Hee 2005, ‘Acne vulgaris: a review of antibiotic therapy’, Expert opinion on pharmacotherapy, vol. 6, no. 3, pp. 409—418. <https://www.tandfonline.com/doi/abs/10.1517/14656566.6.3.409?journalCode=ieop20>, accessed 23rd June 2020.
  11. American Academy of Dermatology, How long can I take an antibiotic to treat my acne?, <https://www.aad.org/public/diseases/acne/derm-treat/antibiotics>, accessed 23rd June 2020.
  12. American Academy of Dermatology, Is any acne treatment safe to use during pregnancy?, <https://www.aad.org/public/diseases/acne/derm-treat/pregnancy>, accessed 23rd June 2020.
  13. All About Acne, Antibiotics for acne, <https://acne.org.au/treatments/acne-medication/antibiotics/>, accessed 24th June 2020.
  14. Bienenfeld, Amanda, Nagler, Arielle R., Orlow, Seth J. 2017, ‘Oral antibacterial therapy for acne vulgaris: an evidence-based review’, American Journal of Clinical Dermatology, vol. 18, no. 4, pp. 469—490. <https://pubmed.ncbi.nlm.nih.gov/28255924/>, accessed 24th June 2020.

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