Discuss oral antibiotic use in acne vulgaris.

Antibiotics are indicated in patients with inflammatory lesions (red papules, pustules, or nodules) of moderate to severe grade. Antibiotics appropriate for use in acne are the tetracyclines and the macrolides, with trimethoprim/ sulfamethoxasole as a distant alternative. Antibiotics reduce the numbers of P. acnes in the follicles and also have numerous antiinflammatory effects.

Antibiotics should never be used as monotherapy in acne. There is a significant problem with antibiotic resistance, and only two of the four main pathophysiologic mechanisms of disease are being addressed. Oral antibiotics should be combined with a keratolytic such as a topical retinoid and topical benzoyl peroxide. Oral therapy will take 4 to 8 weeks to show significant improvement. After adequate clinical response in 3 to 6 months, the dose should be tapered in an attempt to provide maintenance with topical medications.

Espersen F: Resistance to antibiotics used in dermatological practice, Br J Dermatol 139:4–8, 1998.