The more I learn about antibiotic therapy for acne, the more wary and less enthused I become. Due to overuse and misuse over the past twenty years, antibiotic resistance has become widespread throughout the skin of the world population. This is evidenced by the increasing ineffectiveness of both oral and topical antibiotics in clinical studies. Antibiotics never worked very well for acne, and now they work even less well.

According to a “Global Alliance to Improve Outcomes in Acne” published in the Journal of the American Academy of Dermatology, antibiotics should be avoided as the sole treatment of acne. Researchers agree strongly that if antibiotic therapy is used, it should be combined with other therapies. When you look at the superior effectiveness of these other therapies the question arises as to why someone would want to include antibiotics at all. For example, when one takes into consideration the fact that benzoyl peroxide kills 99.9% of acne bacteria on its own and does not create resistant colonies of bacteria, one has to wonder why so many prescriptions for antibiotic acne therapy–over 11 million per year–are still written. According to an article published in the journal Expert Opinion on Pharmacotherapy, “…evidence demonstrates that [topical antibiotics] are no more effective against inflamed lesions than [benzoyl peroxide], and are less effective against non-inflamed lesions…To date, [benzoyl peroxide], as both mono- and combination therapy, is the most evidence-based approach.” Other acne treatments exist, and while they may not be as effective as benzoyl peroxide, they easily outpace antibiotics.

The misuse of antibiotics can also cause antibiotic resistance in other skin bacteria, especially the bacteria known to lead to impetigo and folliculitis. If all of this weren’t enough, when we look at how gene mutations work in bacteria, we see that genes which allow for resistance to antibiotics are easily transferred from acne bacteria to other bacteria in the skin, thus further promoting unwanted antibiotic resistance in other skin bacteria.

If your doctor has you on antibiotic therapy for acne and nothing else, it may be time to have a talk with her/him. The authors of the expert opinion review also note that topical antibiotics should be used for no longer than 3 months and oral antibiotics for no longer than 6 months. So, if you have been on antibiotic therapy for a long time, it may also be time for an appointment with your dermatologist. Since poor compliance with antibiotic regimens are one of the main causes of antibiotic resistance, just make sure you do not stop antibiotic therapy on your own without consulting with your physician first.

16 Responses to “Antibiotic therapy for acne. Cause for concern.”

  • Kelsey L.

    Two years ago my doctor put me on oral Minocycline for my acne. It completely cleared up my skin 100% within 2 weeks. I had absolutely no acne. Benzoyl peroxide never did that for me, and I had been using the Regimen for about a year prior to taking the antibiotics. Unfortunately, I had to stop taking it due to the adverse side effects that I started experiencing (nausea, diarrhea, and extreme dizziness). My acne came back. I haven’t found anything that’s worked so well for me since then.

  • Jake

    I like using bp but it makes my skin so dry and flakey that I need a better moisturizer. Any plans to bring out the old one? It worked great for me because it took away the dryness. Now I am considering antibiotics because I can’t handle bp without a good moisurizer. 5 pumps plus 10 drops of jojoba oil doesn’t even work for me… ?

  • Lawl

    The “old” pumps leak and the “new” (now discontinued) pumps break. I just got a shipment with the “old” pumps and it leaked. Maybe you should try a third pump?

  • D

    Prolonged use of antibiotics is indeed very bad, but for short term initial clearing in combination with a retinoid cream it does work well for many people. My current dermatologist who is a clinical professor at Yale medical school does not use antibiotics as standard treatment for acne. He likes to substitute antibiotics with sodium sulfacetemide (Klaron) which is anti bacterial but bacteria doesn’t build resistance to it. BP is very harsh on the skin and many patients give up on their dermatologists when they prescribe BP. In theory BP sounds and works well but in reality a good number of population just can not tolerate it; otherwise, we wouldn’t turn to dermatologists if BP magically worked for people.

  • pityriasisrosearelief.com

    Doctors keep trying to treat the symptoms rather than the ROOT CAUSE. That’s why with the use of antibiotics, they work for the short term, but later revert back. Antibiotics are not a long term solution for acne. In the end..it does more damage than good.

  • Sheryl

    This has nothing to do with the topic at hand…but I don’t know where else to post it so that Dan will see it.

    I have been a user of your products for years. A few months ago you blogged about the ingredient niacinamide in products. Some of us noted that we hope your change the formulation of your moisturizer to include niacinamide.

    I just have to say that the combination of benzoyl peroxide and niacinamide cresms (Olay products) has drastically changed the appearance of my skin. Not only do I not break out (because of the BP), but the niacinamide prevents the iirritation I used to experience from BP, and has totally retexturized my skin.

    I read in PubMed that Niacinamide in skin creams comes closest to the “gold standard” Retin A, in its activity on skin. The article said that niacinamide is the only cosmecutical that even comes close, due to all the testing on it.

    Olay recently came out with an Acne Protocol that includes salicylic acid and niacinamide. They really missed the mark. Their product was awful. The only good thing about it was the niacinamide cream.

    You can really be on the cutting edge if you give us a system that includes BP along with niacinamide. I always feel badly when I buy my Olay stuff, because I would rather support you instead!

    Well, here’s hoping that in the future you can give us a combnation BP/Niancinamde protocol. Wow, Olay really missed the mark on that one. Just imagine, you could do what a giant company like Procter and Gamble could not!

  • Anonymous

    i believe antibiotics are one of the worse things you can use for acne.

    I used them for only 5 months… and it gave me the worst seborrheic dermatitis ever. I have clogged pores, weird texture, weird raised lesions all over my face thanks to doxycycline.

  • Anonymous

    Hey D, who is your dermatologist? I would love to contact him and maybe visit him regarding my condition

  • k

    Think long and hard before using antibiotics for acne. My derms put me on antibiotics for my acne throughout my college years. I didn’t know any better and followed their advice. I had bearable skin that still broke out. If I had to do it all over again I wouldn’t touch the stuff. It threw off the balance of bacteria in my body so bad that I suffered for years from severe yeast infections….uncomfortable, embarrassing and frustrating…and I still have issues 20 years later. Just don’t do it.

  • Gail Sherman

    I AM ABSOLUTELY AMAZED THAT YOU STATE THAT NO-ONE KNOWS WHAT CAUSES ACNE11111111111

    Acne is caused by circulating androgens rising above the threshold the skin will tolerate. This was stated as far back as 1927 by Professor Hamilton of Edinborugh University, Scotland.

    This can be very easily verified as acne can be induced by simply injecting any androgenic hormone, (steriods are notorious for this).

    Acne is TOTALLY DUE TO HORMONAL IMBALANCE.

    No-one gets acne before puberty. All female acne sufferers can confirm that right before the onset of the period the acne is worse. This is due to oestrogen falling to it’s lowest level in the cycle.

    Acne is associated with a myriad of other disorders

    Cystic ovaries
    Hirsutism
    Migrane
    Serious depression (due to the biochemical imbalance)

    These disorders all stem from an oestrogen deficiency.

    Acne is a vicious, complex and dangerous disease. It is absolutely not a skin disorder. It is nature’s way of letting you know that the hormones
    are unbalanced.

    I totally agree with K it is idiotic and ignorant to use antibiotics for acne.
    The only thing that will be achieved is destruction of the intestinal and vaginal flora, and probably serious damage to the liver and kidneys . It is even more tragic that after all of that the patinet’s acne has certainly not been treated, and at that stage the acne sufferer has several other complications.

  • Melissa

    Long-term antibiotic use will Mess. You. Up. A close friend of mine whose acne was treated with antibiotics for years is still suffering ill health effects from it. True story.

  • Amy

    I have been using Clindagel for more than half a year. So far my skin has improved, but breakouts do occur. I really like using it……but if i dont know if it a topical anti-biotic gel?

    And i do the regimen to control my breakouts! love it :)

  • jess

    Just wanted to say, I too used oil of olays new acne prox and it was horrible! Made my hormonal acne 100% worse. As to antibiotics, every time I take them for something else they make my acne worse in addition to tearing up my digestive tract and giving me a yeast infection. Overuse/abuse of antibiotics is serious business I can’t believe anyone would still prescribe it for acne

  • Roel from Holland

    Due to moderate to severe acne, I was on antibiotics for 2,5 years. At first, it worked perfectly, but over the years my acne returned. I even suspect that I suffered from folliculitis after two years – deep, big, and hard lesions in my neck – but this was never confirmed by a doctor. Anyway, at that point I threw away the antibiotics and started with the regimen. It took a few months for it to ‘kick in’ but ever since I have my acne under control.

    Unfortunately, I am still suffering from bad digestion – very prone to diarrhea – as a result of the 2,5 years of antibiotitcs. I strongly recommend everybody that takes antibiotics to reconsider. There are other ways of getting clear. For me personally, the regimen was the answer.

  • Christian Healing Retreat

    I’m also suffering from acne since a long time..I think you are right here, antibiotics are not long term solution for acne. I’m taking antibiotics for a long while but I’m not getting any relief now. I’ve stopped taking it.

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