Table 4.
Oral antibiotics used for treating acne
| Drug | Effectiveness | Evidence for effectiveness v placebo | Evidence for effectiveness v other oral antibiotics | Side effects |
|---|---|---|---|---|
| Erythromycin | Little evidence, clinically beneficial | No RCTs* | =Doxycycline (1 RCT)w22; =tetracycline (1 RCT)w23 | Nausea, vomiting, and diarrhoea. May cause failure of oral contraceptives |
| Doxycycline | Reduces inflammatory and non-inflammatory lesions | 1 RCTw24 | =Erythromycin (1 RCT)w22; =oxytetracycline (1 RCT)w25 | See footnote† |
| Lymecycline | Little research evidence, clinically beneficial | No RCTs* | =Minocycline (1 systematic review)14 | See footnote† |
| Oxytetracycline | Little research evidence, clinically beneficial | No RCTs* | =Doxycycline (1 RCT)w25 | See footnote† |
| Minocycline | Little research evidence, clinically beneficial | No RCTs*14 | =Doxycycline, lymecycline, tetracycline (1 systematic review)14 | Can cause irreversible pigmentation. Associated with a higher risk of liver damage and systemic lupus erythematosus than the other tertracyclines†14 |
| Tetracycline | Reduces severity of acne | 2 systematic reviews11,12 | =Minocycline (systematic review)14; =erythromycin (1 RCT)w23 | See footnote† |
RCT=randomised controlled trial.
Evidence of effectiveness based on comparative or non-placebo controlled RCTs.
Oral tetracyclines may harm developing bones and teeth and should not be taken in pregnancy or when breastfeeding. They should not be prescribed to children under 12. They may cause failure of oral contraceptives in the first few weeks of treatment. Other adverse effects include nausea, vomiting, diarrhoea, dysphagia, and oesophageal irritation. Rare side effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity and hypersensitivity reactions, and benign intracranial hypertension. Tetracyclines should be used with caution in patients with myasthenia gravis, hepatic problems, or renal impairment. Tetracyclines interact with a wide range of other drugs. Many indigestion remedies reduce the absorption of tetracyclines. Milk reduces the absorption of oxytetracycline and tetracycline.