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Oral Antibacterial Therapy for Acne Vulgaris: An Evidence-Based Review

Abstract

Background

To some degree, acne vulgaris affects nearly every individual worldwide. Oral antibiotic therapy is routinely prescribed for the treatment of moderate to severe inflammatory acne; however, long-term use of oral antibiotics for acne may have unintended consequences.

Objective

The aim of this study was to provide a systematic evaluation of the scientific evidence on the efficacy and appropriate use of oral antibiotics in the treatment of acne.

Methods

A systematic search of MEDLINE was conducted to identify randomized controlled clinical trials, systematic reviews, and meta-analyses evaluating the efficacy of oral antibiotics for acne. Overall, 41 articles that examined oral antibiotics compared with placebo, another oral therapy, topical therapy, alternate dose, or duration were included in this study.

Results

Tetracyclines, macrolides, and trimethoprim/sulfamethoxazole are effective and safe in the treatment of moderate to severe inflammatory acne. Superior efficacy of one type or class of antibiotic could not be determined, therefore the choice of antibiotic is generally based on the side-effect profile. Although different dosing regimens have been studied, there is a lack of standardized comparator trials to determine optimal dosing and duration of each oral antibiotic used in acne. The combination of oral antibiotics with a topical therapy is superior to oral antibiotics alone.

Conclusion

This article provides a systematic evaluation of the scientific evidence of the efficacy of oral antibiotics for acne. Due to heterogeneity in the design of the trials, there is insufficient evidence to support one type, dose, or duration of oral antibiotic over another in terms of efficacy; however, due to increasing resistance to antibiotics, dermatologists should heed consensus guidelines for their appropriate use.

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Correspondence to Seth J. Orlow.

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Amanda Bienenfeld and Arielle R. Nagler have no conflicts of interest to disclose. Seth J. Orlow serves as a board member for Almirall and, once a year, as an advisory board member for Unilever.

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Bienenfeld, A., Nagler, A.R. & Orlow, S.J. Oral Antibacterial Therapy for Acne Vulgaris: An Evidence-Based Review. Am J Clin Dermatol 18, 469–490 (2017). https://doi.org/10.1007/s40257-017-0267-z

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Keywords

  • Acne
  • Doxycycline
  • Minocycline
  • Benzoyl Peroxide
  • Roxithromycin