Antibiotics For Acne

  • Irenosen AddehMaster of Science (MSc), Public Health, University of Debrecen, Hungary
  • Regina LopesSenior Nursing Assistant, Health and Social Care, The Open University

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Do you struggle with breakouts and don’t know why? Is it making you insecure, and do you want to make it go away? Understanding acne is essential to tackling its root causes. In this article, we will shed light on the different types of acne, their causes, and their treatments.

Acne, also known as acne vulgaris, is a very common inflammatory disease that affects our skin.1 It affects more than half of young adults and adolescents.1 It is treated with multiple medications, such as steroids lithium, and antibiotics.2 In this article, we will focus on antibiotics and their efficacy in acne treatment.

Understanding acne

Acne can arise from a multitude of causes, and they include:1,3

  • Sebum production: Excess oil from sebaceous glands can clog our pores and cause acne
  • Irregular follicular shedding: When dead skin does not shed properly, these cells can accumulate in the pores (along with the sebum)
  • Bacteria: Propionibacterium Acnes, a bacterium naturally present in our skin, can trigger acne lesions; it lives in areas full of sebaceous follicles that provide it with a lipid-rich, anaerobic environment
  • Hormones: Androgens, such as testosterone, can stimulate the production and secretion of sebum, which can trigger acne breakouts. Additionally, hormonal fluctuations seen during puberty and pregnancy can have an effect
  • Medication: certain medications like halogens, androgens and pore-clogging pore cosmetics can flare up acne
  • Stress: stress can make the healing process longer and exacerbate the lesions

Different types of acne

Non-inflammatory acne

  • Whiteheads (Closed Comedones): Whiteheads are non-inflammatory acne lesions that form when hair follicles become clogged with oil and dead skin cells. The pore is closed, and the bump appears as a small, flesh-coloured or whitish bump on the skin
  • Blackheads (Open Comedones): Blackheads are like whiteheads, but the pore is open, exposing the contents to air. The dark colour comes from the oxidation of the oil and dead skin cells, not dirt

Inflammatory acne

  • Papules are small, raised, red bumps often tender to the touch. They result from inflammation and infection of the hair follicles
  • Pustules are similar to papules but contain pus at their tips. They are often red at the base with a yellow or white centre
  • Nodules are larger, solid, painful lumps beneath the skin's surface. They develop when clogged, swollen pores cause deep tissue inflammation
  • Cysts are severe forms of acne lesions that are large, pus-filled, and painful. They can cause scarring and may require medical intervention for treatment


  • Acne rosacea: This type of acne primarily affects the face and is characterised by redness, flushing, and the development of small, red, pus-filled bumps. It is different from traditional acne
  • Acne conglobata: This is a severe and rare acne characterised by large, interconnected nodules. It can cause widespread skin damage and scarring
  • Acne mechanica: This type of acne is triggered or worsened by heat, friction, or pressure on the skin. It is common among athletes who wear equipment that traps heat and sweat

Dealing with acne has many adverse effects on young teenagers and adults. It can cause discomfort, emotional stress, disfigurement and even permanent skin scarring.1 It can also induce anxiety and embarrassment in a lot of patients, which lowers their social activities and, as a result, affects their well-being.1,3

Role of antibiotics in acne treatment

When faced with acne due to bacterial growth, the use of antibiotics becomes an option, especially when the condition is moderate to severe.4 Antibiotics attacking the bacteria causing acne, inhibit its growth, and provide anti-inflammatory relief.4 They can be categorised into two groups: oral and topical.

Oral Antibiotics for Acne

Oral antibiotics can be given to treat acne. Some of these antibiotics are listed in Table 1.

Table 1. Oral antibiotics used in the treatment of acne.4

Tetracycline250-500 mg, twice dailyLow cost.Take on an empty stomach.Pregnant women and children below the age of 9 should not take the drug
Minocycline50-200 mg, dailyTaken ± food.Pregnant women and children below the age of 9 should not take the drug
Doxycycline100-200 mg, dailyTaken ± food.Acceptable for patients with kidney failurePregnant women and children below the age of 9 should not take the drug
Erythromycin500 mg, twice dailySafe for pregnant women and children. 42% of patients may show resistance to Propionibacterium acnes
Trimethoprim/sulfamethoxazole80/400 mg or 160/800 mg, 4 times a dayBeneficial in patients resistant to other antibiotics

Topical antibiotics for acne

Topical therapy is the recommended treatment for mild to moderate acne. The cornerstones of topical acne treatment include retinoids and antimicrobials, such as antibiotics and benzoyl peroxide. These treatments are active at application sites and help prevent new lesions.4

Topical antibiotics like erythromycin and clindamycin are generally well-tolerated and decreased the inflammatory lesions by 46% to 70% in multiple randomised controlled trials. Monotherapy with topical antibiotics should be avoided routinely because Propionibacterium acnes may become resistant within one month after daily treatment has begun.4

Effectiveness and considerations

Topical antibiotics are effective in treating mild acne; however moderate to severe acne will require systemic therapy.4 The primary systemic therapies include oral antibiotics, hormonal treatments and isotretinoin.4

Like any therapy, treatment with antibiotics will have its flaws and side effects; possible side effects include:5

Therefore, it is essential to commit to treatment once prescribed and adhere to it properly to avoid side effects; compliance with personalised treatment will provide the best results. Table 3 shows an example of treatment times and their impact on lesion reduction.

Table 2. Reduction in inflammatory lesions with various treatment times.5

ENDPOINT (weeks)Doxycycline (%)Minocycline (%)Trimethoprim/sulfamethoxazole (%)

Antibiotic resistance

Traditionally, the definition of antibiotic resistance has come from an operational perspective, which divides bacteria into resistant and susceptible groups based on the possibility of treating the infections they produce. Clinically, a resistant microorganism is defined by an antimicrobial activity level associated with a high probability of therapeutic failure.6

Due to the repetitive use of antibiotics, resistant strains started to emerge. This made the treatment with antibiotics tricky as the usual route taken is the addition of a new type of antibiotic.5 Hence, some previously used antibiotics, such as erythromycin and clindamycin, are no longer used clinically because of their high resistance rates.5

This is a grave concern that caused the Centres for Disease Control and Prevention (CDC) and the World Health Organisation (WHO) to promote campaigns to face antibiotic resistance five actively The WHO employed a global action plan aimed at improving awareness and understanding in the community and optimising the use of antibiotics by the providers (healthcare professionals).

Additionally, the CDC promotes antibiotic stewardship, which means that physicians should act responsibly when prescribing antibiotics to patients. This is in the hope of limiting the progression and expansion of antibiotic resistance.

Alternative and complementary treatments

As mentioned before, systemic and combinational treatments are considered with antibiotics for more severe cases of acne. Some of these treatments include benzoyl peroxide and retinoids.4 However, there are other options to consider that can be complementary to treatment:7,3

Diet: Studies suggest that the regular consumption of omega-3 fatty acids and low-carb (or food that increases blood sugar levels) diets can reduce the occurrence of acne.

Daily life: Many things we do on a daily basis can provoke acne, and we can do things to avoid that from happening. For example, phones and pillowcases can accumulate oil, dirt, and bacteria, affecting the skin and promoting acne growth. Using soap (which is a harsh chemical) can affect the skin's pH, leaving it dry and irritable, which can cause breakouts. Hence, a proper skincare routine is advisable.

Consultation with healthcare professionals

It is vital to consult a healthcare professional, usually a dermatologist, to determine the most suitable antibiotic treatment based on the patient’s skin characteristics and acne stage/severity. Additionally, non-antibiotic options are available, and a comprehensive approach that includes lifestyle and skincare considerations is often recommended for effective acne management.


Antibiotics are commonly prescribed for acne treatment to address the bacterial component (Propionibacterium acnes) involved in acne development. However, their use has proven to yield antibiotic resistance ,which is a significant health concern. Hence, alternative therapies are more desired. It is essential to use antibiotics responsibly to have a strong and long-lasting option of therapy. 


  1. Fox L, Csongradi C, Aucamp M, Du Plessis J, Gerber M. Treatment modalities for acne. Molecules [Internet]. 2016 Aug [cited 2024 Jan 18];21(8):1063. Available from: 
  2. Feldman S, Careccia RE, Barham KL, Hancox J. Diagnosis and treatment of acne. afp [Internet]. 2004 May 1 [cited 2024 Jan 18];69(9):2123–30. Available from: 
  3. Bhadra P, Deb A. A literature review onacne due to hormonal changes and lifestyle. Indian Journal of Natural Sciences [Internet] 2020 Apr [cited 2024 Jan 18];10(59). Available from: 
  4.  Kraft J, Freiman A. Management of acne. CMAJ [Internet]. 2011 Apr 19 [cited 2024 Jan 18];183(7):E430–5. Available from: 
  5. Baldwin H. Oral antibiotic treatment options for acne vulgaris. J Clin Aesthet Dermatol [Internet]. 2020 Sep [cited 2024 Jan 18];13(9):26–32. Available from: 
  6. Martinez JL. General principles of antibiotic resistance in bacteria. Drug Discovery Today: Technologies [Internet]. 2014 Mar 1 [cited 2024 Jan 18];11:33–9. Available from: 
  7. Baldwin H, Tan J. Effects of diet on acne and its response to treatment. Am J Clin Dermatol [Internet]. 2021 [cited 2024 Jan 18];22(1):55–65. Available from: 

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Tatiana Abdul Khalek

PhD, Anglia Ruskin University, UK

I am a PhD student in Biomedical Science at Anglia Ruskin university and work as a quality control (QC) analyst (microbiology/chemistry) at EuroAPI. I have a MSc in Forensic Science from Anglia Ruskin (Cambridge) and I had experience in different roles such as quality lab technician at Fluidic Analytics, Research Assistant/Lab Manager at Cambridge University and Forensic Analyst at the The Research Centre in Topical Drug Delivery and Toxicology, University of Hertfordshire.

My PhD revolves around the use of nanoparticles and their role in cartilage degradation, as well as their potential as drug delivery vehicles for the treatment of diseases such as leukaemia.

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