Should you take antibiotics for acne? A complete guide
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Antibiotics are a common treatment option prescribed by Doctors for acne and it was one of the first (of many) unsuccessful treatments my own Dermatologist prescribed me years ago. The multiple topical and oral antibiotics I was prescribed improved my acne slightly but they certainly didn’t clear me up completely. I am sure there are people who see good results for their acne with antibiotics (I hope there are anyway!) but the most common feedback I hear from many of my own acne clients 20 years later mirrors my own personal experience: slight improvements, no significant long term results. I am sure there are also plenty of people who take antibiotics without ever having to deal with a side effect and severe side effects are uncommon but, unfortunately, I wasn’t one of those lucky ones and it was partially due to the fact that my Dermatologist kept me on it way longer than I should have been. My experience with prescription medication drove me to develop a program that is prescription free, sustainable, and that aims to clear acne completely rather than just improve its symptoms but the AES method is certainly not the easy route and everyone has to choose the acne solution that feels right for them. If antibiotics feel like they might be the right option for you or if you are just curious to learn more about it from the perspective of someone who has had acne and who has successfully coached hundreds of people to clear skin, read on.
HOW THEY WORK
Antibiotics kill bacteria which is supposed to reduce symptoms of inflammation like redness, swelling, and pus but inflammation can be managed just as well (if not better) with benzoyl peroxide and icing which are both important parts of our acne program. The worst side effect of icing is that it can be too cold but that is nothing compared to the potential side effects of antibiotics. And the worst side effect of benzoyl peroxide is that some people report it stains their pillowcases and clothes (I have personally never had this issue in 20 years of using it) but it should only be used at night anyways so this can be easily remedied by using white pillowcases.
POTENTIAL SIDE EFFECTS
Yeast infections
Bacterial resistance to antibiotics
Clostridium difficile (C. diff) infection
Oral thrush
Gastrointestinal issues (stomach pain, nausea, diarrhea)
Headaches
Photosensitivity
Dizziness
TOPICAL ANTIBIOTICS
Because there is such a high risk of antimicrobial resistance, topical medications are often combined with benzoyl peroxide to reduce the risk of developing resistant bacteria. Common topical antibiotics you might be prescribed are:
Clindamycin such as Cleocin and Clinda Derm
Erythromycin such as E-Mycin
Benzaclin, Duac, Acanya and Onexton (clindamycin + benzoyl peroxide)
Benzamycin (erythromycin + benzoyl peroxide)
Ziana (clindamycin + tretinoin)
ORAL ANTIBIOTICS
Tetracycline is a class of antibiotics that are commonly prescribed for acne. It should be taken on an empty stomach and it should not be taken by pregnant women because it can affect a baby’s bone growth and can also cause their teeth to become stained. It can also cause teeth staining in young children so it’s not recommended for children under 9 years old and it’s sometimes advised to hold off until as late as 12 years old.
Doxycycline belongs to the class of Tetracycline that should be taken with food . Brand names include Doxy, Ocudox, Doryx, Vibramycin, Oracea, Acticlate, Monodox, Atridox, Morgidox, Vibra-Tabs, and Alodox.
Minocycline also belongs to the class of Tetracycline. Brand names include Mino-tabs and Minomycin.
Erythromycin Ilotycin, Ery-Ped, Ery-tab, Staticin, Erythra-Derm, Akne-mycin, Pce, Eryc, Ery, Eryped, T-Stat, Erygel, and E.E.S.
Azithromycin. Brand names include Zithromax Z-Pak, AzaSite, Zithromax TRI-PAK, and Zmax.
Clindamycin is an oral antibiotic but it also comes as a topical solution. Brand names include Clindagel, Cleocin-T, Evoclin, Clinda-Derm, Clindets, and C/T/S.
Trimethoprim/Sulfamethoxazole (TMP/SMX) is a combination antibiotic that should not be taken while pregnant or breastfeeding. Brand names include Bactrim, Bactrim DS, Sulfatrim, and Septra I.V.
Trimethoprim
Cephalexin
BACTERIA DOES NOT CAUSE ACNE
If I could go back in time to that moment my Doctor prescribed me antibiotics, I would tell myself what I know now: Bacteria doesn’t cause acne! Propionibacterium acnes (P. acnes) was actually misnamed when scientists and Doctors mistakenly thought that acne was caused by this bacteria. We now know that acne is not caused by this bacteria or any bacteria, it’s caused by Retention Hyperkeratosis. We also know now that EVERYONE has P. acnes living in their skin and those of us with acne don’t even have more of it than people with clear skin. It’s just that this bacteria is anaerobic which means that it can’t exist in an environment where there is oxygen. People without acne have a constant flow of oxygen circulating in their follicles because they are clear of congestion. Those of us with RH have congestion due to the back up on dead skin cells, oil, and comedogenic products so oxygen isn’t able to reach inside of the follicle and bacteria gets the perfect environment to thrive in. P. acnes also feeds off of oil but it only eats a portion of the oil and then it basically poops the rest in the follicle causing irritation and leading to inflammation. But, again, inflammation is just a symptom of the bacteria overgrowth and the overgrowth of bacteria is just a symptom of the RH so both bacteria and inflammation stop being a problem once the underlying RH is dealt with.
BACTERIA IS MOSTLY GOOD AND ESSENTIAL TO LIFE
Even if bacteria did cause acne, killing all of the bacteria with antibiotics is something that should only be done when absolutely necessary. Bacteria has a bad reputation as something dirty and dangerous that needs to be sanitized but most of the bacteria in our bodies are good and they are an essential part of the human microbiome. They live all over and within our bodies throughout our entire lives and they aid in crucial processes like fighting disease, growth, digestion, and regulating mood and although some species can cause infection or disease, they usually only do when the natural microbiome is disturbed.
ANTIBIOTICS CREATE SUPER BACTERIA
In recent decades, antibiotics have been so frequently prescribed and people have been kept on them for such long periods of time that there has been increased rates of antimicrobial resistant “super bacteria”. Because antibiotics throw off the balance of good and bad bacteria, the bacteria that survive adapt and morph into stronger strains that are resistant to antibiotics. It’s almost like antibiotics have acted as vaccines for bacteria and bacteria have become more and more immune to them. The bacteria that cause tuberculosis, malaria, and gonorrhea, for example, now have several antibiotic resistant strains and propionibacterium acnes is now becoming more resistant as well.
TO GET COMPLETELY CLEAR LONG TERM, YOU HAVE TO DO THIS
It amazes me that 20 years after antibiotics are still such a commonly prescribed treatment for acne because I have yet to meet one person who actually got completely clear long term from it. Antibiotics can be helpful in reducing some of the inflammatory symptoms of acne which might make your acne look less noticeable. But the results are not usually sustainable after you get off of antibiotics which you have to do at some point for your health. And improvements, if any, are often unimpressive because acne is a multifactorial disease that is caused by so much more than bacteria. At the root of acne is a genetic disease called Retention Hyperkeratosis and there are many potential triggers and symptoms that play a role in exacerbating RH so to get completely clear long term usually requires a whole-istic approach that deals with not just symptoms like bacteria but the underlying cause, the dozens of triggers, and each of its symptoms which is what our acne fighting program does.
