Most Doctors Are OK with Prescribing Them Together as Long as You Use a Second Method of Birth Control
The Essential Info
Doctors sometimes prescribe both birth control pills and antibiotics at the same time for women who suffer from acne, and rumors abound that antibiotics lead to breakthrough pregnancy (pregnancy while on birth control). However, research indicates that there is only a negligible risk of breakthrough pregnancy.
Even though this risk is slight, scientists recommend using a second method of birth control while taking these two medications at the same time.
One Exception – Rifampin: An antibiotic called rifampin may reduce the efficacy of oral contraceptives, and women taking it should be aware of the risk of breakthrough pregnancy. Doctors do not prescribe rifampin for acne, but if you’re on it for any other reason, it’s best to use a backup method of contraception.
Caution: Antibiotics should be a last resort when it comes to acne treatment. Physicians understand this and prescribe them less for acne today than in the past. This is because antibiotics usually do not provide satisfying results, offer only temporary relief, and cause resistant strains of bacteria in about half of users, particularly when they are used for longer periods of time (over 3 months).
Doctors sometimes prescribe both birth control pills and oral antibiotics to treat acne in women. In addition, many women use birth control pills to prevent pregnancy and to treat other conditions, such as menstrual problems, and then their doctors prescribe oral antibiotics for acne.
Research indicates that there is an extremely small risk that taking antibiotics while on birth control pills results in breakthrough pregnancy, which occurs when a woman gets pregnant even though she uses birth control. Because of this risk, scientists recommend caution and using a second method of birth control when taking these medications at the same time, particularly when using an antibiotic called rifampin.
Let’s have a deeper look now and see what the studies say.
Do Oral Antibiotics Make Birth Control Pills Less Effective?
Four large systematic reviews investigated the evidence concerning whether antibiotics make birth control pills less reliable. Systematic reviews are rigorous literature reviews that look at multiple studies and pool the results into a combined analysis. This type of review is considered to be the highest level of evidence.
Overall, these reviews have found that there is little chance of breakthrough pregnancy when using antibiotics prescribed for acne, but particular care should be taken in women who are using an antibiotic called rifampin.1-4
Expand to read details of reviews
Two other, less rigorous studies came to conflicting conclusions. While one study found that antibiotics increased the risk of breakthrough pregnancy while on birth control, the second study found no connection between taking antibiotics and breakthrough pregnancy.5,6
Expand to read details of studies
The World Health Organization stated in 2004 that, while there are suspicions that antibiotics reduce the effectiveness of birth control pills, breakthrough pregnancy rates among women taking both antibiotics and birth control pills are similar to those taking only birth control pills.7
We can conclude from these studies that the only scientific evidence thus far is that rifampin reduces the reliability of birth control pills. However, multiple cases of breakthrough pregnancies have been reported over the years when antibiotics and birth control pills are taken simultaneously. These reports include a variety of antibiotics. Given the many cases of breakthrough pregnancies, it is prudent to employ a second method of birth control while taking antibiotics.
- Zhanel, G. G., Siemens, S., Slayter, K. & Mandell. L. Antibiotic and oral contraceptive drug interactions: is there a need for concern? Can. J. Infect. Dis. 10, 429 – 433 (1999). https://www.ncbi.nlm.nih.gov/pubmed/22346401
- Dickinson, B. D., Altman, R. D., Nielsen, N. H. & Sterling, M. L. Drug interactions between oral contraceptives and antibiotics. Obstet. Gynecol. 98, 853 – 860 (2001). https://www.ncbi.nlm.nih.gov/pubmed/11704183
- Archer, J. S. & Archer, D. F. Oral contraceptive efficacy and antibiotic interaction: a myth debunked. J. Am. Acad. Dermatol. 46, 917 – 923 (2002). https://www.ncbi.nlm.nih.gov/pubmed/12063491
- Simmons, K.B., Haddad, L.B., Nanda, K. & Curtis, K.M. Drug interactions between rifamycin antibiotics and hormonal contraception: a systematic review. BJOG 125, 804-811 (2018). https://www.ncbi.nlm.nih.gov/pubmed/29130574
- Koopmans, P. C., Bos, J. H. & de Jong van den Berg, L. T. Are antibiotics related to oral combination contraceptive failures in the Netherlands? A case-crossover study. Pharmacoepidemiol. Drug Saf. 21, 865 – 871 (2012). https://www.ncbi.nlm.nih.gov/pubmed/22553004
- Toh, S., Mitchell, A. A., Anderka, M., de Jong-van den Berg, L. T. & Hernandez-Diaz, S. Antibiotics and oral conceptive failure- a case-crossover study. Contraception 83, 418 – 425 (2011). https://www.ncbi.nlm.nih.gov/pubmed/21477683
- Bauer, K. L. & Wolf, D. Do antibiotics interfere with the efficacy of oral contraceptives? J. Fam. Pract. 54, 1079 – 1080 (2005). https://www.ncbi.nlm.nih.gov/pubmed/16321347