Best Antibiotics for Acne, Oral, Topical, Side Effects, Good Bacteria, Mechanism of Antibiotic for Acne

Antibiotic treatments are a popular treatment option for dermatologists in the control of moderate to severe acne. But, is this necessary or is there another option? Find out about the benefits and risks of antibiotic therapy.

The skin is the largest organ of the body and is the target site of acne eruptions; which is aggravated by the presence of bad bacteria. There are actually two types of bacteria: the good bacteria also known as normal flora, which are helpful to the body; and the bad bacteria, or pathogens, which are harmful to the body and causes diseases.

Good Bacteria versus Bad Bacteria

The human body is composed of trillions of cells, but, is actually harboring ten times more of good bacterial cells. The human cells and good bacteria exist in a mutually beneficial relationship. Good bacteria help the body in several ways: they fight bad bacteria to prevent diseases, they provide nutrition, vitamins and eliminate toxins, and improves digestion and the immune system.

Antibiotics for Acne, Best Oral, Topical, Side Effects, Good Bacteria, Mechanism

Antibiotics for Acne

The good bacteria play an important role in acne prevention by helping in the digestion of dairy products and fatty foods in the gut. Good absorption of these food products mean, they will not be manifested as an oily skin. It is a fact that although the oil itself does not cause the acne, it triggers the eruption because too much oil in the face attracts and traps the bad bacteria.

The good bacteria works like the planet Earth, where there are different environments like dry desserts, rain forests and cold winter snow. These areas exist for a particular reason and all together they bring balance to the environment. In comparison, the good bacteria exist in different areas of the body like skin, oral and nasopharyngeal area, intestinal area and urogenital area. These areas house various good bacteria, where they can be most helpful to the host and where the environment will allow them to survive.

On the other hand the human body / cell serves as the host that provides a steady source of nutrients, a stable environment, protection and transport for the good bacteria.

How Good Bacteria in the Gut Help the Body

If the human body is composed of 100 trillion cells, the intestines house the largest reservoir of about 1000 trillion good bacterial microorganisms. 30% of gut bacteria belong to the genera such as Bacteroides,Clostridium, Fusobacterium, Eubacterium, Ruminococcus, Peptococcus and Lactobacillus to name a few.

Since these good bacterial cells are very important to the human body, it is just as important to foster their growth to ensure better health. Their role in fat absorption, digestive protection and improvement of the immune system cannot be matched; the very reason why a lot of prebiotics or dietary components are made available to help maintain their presence in the gut.

This principle is directly opposed by the use of antibiotics, because these drugs exploit the good bacteria creating very harmful effects to the whole body.

Facts about antibiotics

To understand how antibiotics work, a brief understanding of their framework is important.

  • An efficient antibiotic medication should generally have more benefits to the person and exhibit more toxicity to the bad bacteria.
  • Antibiotics have a needed dose to be effective and have a dose that is considered toxic to a person; the former should have a higher ratio than the latter.
  • Antibiotics can either be bactericidal, that kills the bacteria or bacteriostatic, that stops the growth of bacteria.
  • Antibiotics before given to a person should be tested for culture and sensitivity to determine which ones will be effective and which ones will be not. The reason for this is because there are certain bacteria that develop immunity to certain antibiotics.
  • In cases of bacterial immunity, a combination of two or more strong antibiotics will be needed to kill the bacteria.
  • Antibiotics are classified as broad spectrum, damaging or killing gram-positive, gram-negative and good bacteria. Narrow spectrum antibiotics on the other hand have the same effects, but, to specific family of bacteria only.
  • Broad spectrum antibiotics are necessary only if immediate treatment is needed, if a serious illness is being diagnosed and when treating persons with drug resistant illnesses or super infections.

Best antibiotics used in the treatment of acne

Tetracyclines are a family of broad-spectrum bacteriostatic antibiotics that include tetracycline and minocycline, commonly used antibiotics for acne. Tetracycline became popular in acne treatment, until Minocycline, a semisynthetic derivative of tetracycline was discovered. Minocycline’s distinct characteristic is its long acting effect and its broader spectrum in several gram positive and gram negative bacteria as compared to Tetracycline.

Tetracyline and Micocycline were both used in several serious and rare bacterial infections. Tetracycline was used in Rocky Mountain spotted fever, coxiella and psittacosis, also with the fatal meningococcemia and endemic malaria.

Minocycline’s primary use on the other hand is in the treatment of tick fever, amoebic dysentery, anthrax, periodontal disease and pneumonia. The American College of Rheumatology also recommended its use in the treatment of mild rheumatoid arthritis and is recognized as a DMARD (Disease-Modifying Anti-Rheumatic Drug).

Both antibiotics were used in the treatment of infections of the respiratory tract, urinary tract, gastro-intestinal tract, skin and mucous membranes. They were also found effective for cholera, typhoid fever, anthrax and sexually transmitted diseases, chlamydia, syphillis and gonorrhea.

Another antibiotic used in acne is Erythromycin, another bacteriostatic agent that belongs to the family of macrolides, which in higher doses displays a bactericidal ability and has an antimicrobial strength like that of penicillin. Other than acne, Erythromycin is used to treat bacterial infections of streptococcal origin like infections of the throat (“strep throat”) and skin, also with pneumonia.

It is also used to treat acute pelvic inflammatory diseases, diphtheria, whooping cough, and intestinal amoebiasis; staphylococcal infections of the skin and sexually transmitted diseases like syphilis, gonorrhea, and chlamydia. For patients with rheumatic heart disease who are allergic to penicillin, the alternative medicine of choice is also Erythromycin. Surprisingly, Erythromycin is non-FDA approved in the treatment of acne, lyme disease and tetanus. The distinct characteristic of erythromycin is that it works more efficiently in combination with other antibiotics.

Antibiotic Mechanism of Action

The function of these three antibiotics is to slow down the growth of bacteria, by puncturing the cell walls of the bacteria and then attaching to it with the intention of paralyzing and eventually killing it. The bad news is they do not only affect the bad bacteria but paralyzes and kills the good bacteria as well.

Possible antibiotic for acne Side Effects

Side effects are defined as the untoward symptoms manifested and felt by a person taking antibiotic medications.

Tetracycline and Minocycline side effects:

  • Nausea and vomiting
  • Sore mouth and throat
  • Abdominal pain or stomach upset
  • Diarrhea or loose stools
  • Headache, dizziness or drowsiness
  • Blurred vision
  • Tinnitus or ringing in the ears
  • Allergic reaction like swelling, itching, rashes and difficulty of breathing
  • Skin photosensitivity and discoloration, sunburn
  • Itching of the rectum or vagina
  • Jaundice or yellowing of the skin or eyes
  • Tea-colored urine
  • Light-colored bowel movements
  • Loss of appetite
  • Extreme tiredness or weakness
  • Joint stiffness or swelling
  • Unusual bleeding or bruising
  • Difficulty or decreased urination
  • Teeth staining if used during pregnancy by the mother and discoloration for children if used from 0 to 8 years old.
  • Causes drug-induced SLE (systemic lupus erythematosus) and drug-induced hepatitis (Hepatitis C).
  • Fatty liver and increase of liver enzymes
  • Severe allergic reaction or anaphylactic shock and in rare cases of death.
  • Vision and mental changes

Erythromycin side effects other than those mentioned above:

  • Arrhythmias or irregular and abnormal heartbeat
  • Rare reversible deafness
  • Allergic reactions in severe form may result to anaphylactic shock or Steven Johnson syndrome
  • Rare cases of psychotic reactions like nightmares and night sweats

Special Precautions:

  • Inform your health provider of any allergies especially to tetracycline, minocycline, erythromycin, or any other medications.
  • In form your health provider of any prescription or non-prescription medicines you are taking even nutrional or alternative medicines.
  • Tell your health provider if you have a family history of any or have any of the existing illness like diabetes, asthma, kidney problems, hepatitis, anemia or any other significant disease.
  • Inform your health provider if you are pregnant or breastfeeding or even planning to have pregnancy.
  • Tell your surgeon or dentist that you are taking Tetracycline if you are to have surgery, including dental surgery.
  • Avoid overexposure to direct sunlight; if you cannot avoid it wear enough sun protection.

Special precautions for Erythomycin use other than those listed above:

  • Inform your health provider if you are taking other medications especially those that may affect the hearts’ function and may cause arryhthmias.
  • It is very important to disclose if you have a liver disorder, since erythromycin is directly absorbed via the liver and this may cause aggravation of your condition.
  • Do not crush, chew, break, or open an enteric-coated or delayed-release pill. Swallow the pill whole. The enteric-coated pill has a special coating to protect your stomach. Breaking the pill could damage this coating. The delayed-release pill is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.
  • Be sure to take the medication exactly as prescribed by your health provider.


Be sure to check for the date of expiration before taking minocycline or any other tetracycline as it becomes very toxic way past the expiration. Unlike other antibiotics that simply lose their potency, minocyline and other tetracyclines become very dangerous and pose serious damage to the liver and kidneys.

Effects of Antibiotic Use in the Gut

It is very clear that antibiotic use causes a lot of damage to the good bacteria found in the gut, not to mention that they also damage the lining of the stomach and intestines. For the most part, antibiotics do not discriminate between good and bad bacteria.  Oftentimes, bad bacteria have a stronger cell wall or have become resistant to antibiotics.

This is a very dangerous situation, because not only will the immune system be compromised, but, a more serious situation is when the stomach’s lining is damaged and the bacteria get outside of the intestinal tract. Remember the principle that good bacteria are where they are most useful; this means that outside of the digestive tract they pose a very dangerous and life threatening condition to the person’s health.

The use of broad spectrum antibiotics have a huge effect on the gastrointestinal function that affects the overall health condition of a person, causing a lot of health conditions like: inflammatory bowel disease and colitis that are due to poor immune system and damage to the lining of the colon; obesity is due to the lack of certain good bacteria that aids in absorption of food, particularly fat containing foods; antibiotic-associated diarrhea, due to the irritation in the bowel and another serious adverse effect of antibiotics is the growing number of antibiotic-resistant bacteria that causes more serious illnesses that are difficult to treat with the same antibiotics used in the past.

The overall and initial effect of antibiotics use is a very low immune system. There are signals that can warn you that your body is already depleted of too many good bacteria and they are as follows:

  • Bad breath, is a sign of very low lactobacillus levels in the gut
  • Recurring colds and illnesses like flu
  • Anal itching
  • Cold sores (Herpes Simplex)
  • Diarrhea or Constipation
  • Acne
  • Vaginitis
  • Headache
  • Hypoglycemia or low sugar level
  • Yeast infections

Studies that Show why Antibiotics should not be Used in Acne

The following are excerpts from research studies conducted in different parts of the globe stating the effects of antibiotic use in acne treatment.

Antibiotic resistance, Scientists observe widespread incidence of resistant acne bacteria colonies


Antibiotics have been a mainstay of acne treatment for decades. Antibiotics help kill acne bacteria (P. acnes) and also help reduce inflammation. However, it has also long been noted that they only work for about half of the population, and produce only moderate effectiveness. Next, they often only work for a short period of time. Acne tends to “get used to” antibiotic treatment and become resistant to it.


A large study conducted by the British Journal of Dermatology studied 4274 acne patients and found that since 1991 an average of 51% of patients harbored colonies of resistant bacteria. Other studies have shown similar levels of antibiotic resistant acne bacteria.

How it happens: On a microscopic level, geneticists and biologists are finding multiple possible reasons why this occurs. The first is gene mutation within a bacteria cell. Bacteria have also been observed banding together and producing biofilms, a coating which slows down penetration of antibacterial medication.


“About antibiotic resistance.” APUA: Alliance for the Prudent Use of Antibiotics. 8 April 2009. link. Bojar RA, Holland KT.

“Acne and Propionibacterium acnes.” Clinics in Dermatology. 2004 Sep-Oct;22(5):375-9. Coates P, Vyakrnam S, Eady EA, Jones CE, Cove JH, Cunliffe WJ.

“Prevalence of antibiotic-resistant propionibacteria on the skin of acne patients: 10-year surveillance data and snapshot distribution study.” The British Journal of Dermatology. 2002 May;146(5):840-8. Coates P, Vyakrnam S, Ravenscroft JC, Stables GI, Cunliffe WJ, Leyden JJ, Johnson J, Eady EA, Cove JH.

“Efficacy of oral isotretinoin in the control of skin and nasal colonization by antibiotic-resistant propionibacteria in patients with acne.” The British Journal of Dermatology. 2005 Dec;153(6):1126-36. Del Rosso JQ, Leyden JJ, Thiboutot D, Webster GF.

“Antibiotic use in acne vulgaris and rosacea: clinical considerations and resistance issues of significance to dermatologists.” Cutis. 2008 Aug;82(2 Suppl 2):5-12. Del Rosso JQ.

“Selection of therapy for acne vulgaris: balancing concerns about antibiotic resistance.” Cutis. 2008 Nov;82(5 Suppl):12-6. Dreno B, Reynaud A, Moyse D, Habert H, Richet H.

“Erythromycin-resistance of cutaneous bacterial flora in acne.” European Journal of Dermatology. 2001 Nov-Dec;11(6):549-53.

Randomised controlled multiple treatment comparison to provide a cost effectiveness rationale for the selection of antimicrobial therapy in acne.


The response of mild to moderate inflammatory acne to antimicrobial treatment in the community is not optimal. Only around half to two-thirds of trial participants reported at least a moderate improvement over an 18-week study period; extending treatment beyond 12 weeks increased overall benefit slightly. Around one-quarter of participants dropped out when using such treatments and 55% sought further treatment after 18 weeks. Most improvement was seen within the first 6 weeks.

Implications for healthcare

  • Most people in the community with mild to moderate inflammatory acne of the face respond only partially to topical or systemic antimicrobial treatments. Most of the treatment effect is seen within the first 6 weeks of treatment.
  • The efficacy of systemic tetracycline-based treatments is compromised by pre-existing propionibacterial resistance to the tetracyclines. Local prevalence rates of skin colonisation with antibiotic-resistant propionibacteria may affect the relative efficacy of these treatments.
  • This study has for the first time provided some comparative data for the most popular antimicrobial treatments for facial acne on a level playing field; however, the role of antibiotics in longer term management strategies remains to be elucidated.
  • The results of this study, taken together with the Department of Health Action Plan (June 2000) to reduce selective pressure from antibiotic use, suggest that a reappraisal of antibiotics as first line agents for the treatment of localized acne should be undertaken and that industry independent evidence of the relative efficacy of non-antibiotic-based regimens in mild to moderate disease should be sought urgently.


Randomised controlled multiple treatment comparison to provide a cost effectiveness rationale for the selection of antimicrobial therapy in acne. Ozolins M, Eady EA, Avery A, Cunliffe WJ, O’Neill C, Simpson NB, et al. 2005;9(1).

European recommendations on the use of oral antibiotics for acne’


Safety and tolerability

Tetracycline HCl and oxytetracycline are generally well tolerated, but can produce gastrointestinal disturbances. Like all cyclines, first generation molecules can inhibit skeletal growth in the developing fetus and cause discoloration of growing teeth (particularly with tetracycline HCl). Cyclines are therefore contraindicated during pregnancy and in young children (under 8-12 years, depending on national licenses).

Doxycycline is noted particularly for causing photosensitivity. This effect is dependent on doxycycline dose, UVA intensity, and skin type.

Photosensitivity also greatly increases the potential for phototoxicity (burning effects and photo-onycholysis. Patients and doctors should therefore be conscious of the dangers of UVA solaria when using doxycycline, and this drug should be used with caution in hot climates during the summer. Non-comedogenic sun-screens that protect against both UVB and UVA should be considered when taking doxycycline (depending on dose and climate).

Minocycline causes a number of rare but severe side effects, including autoimmune disorders (lupus-like syndrome, autoimmune hepatitis, arthritis, thyroiditis, polyarteritis nodosa); and hypersensitivity reactions (pneumonitis, eosinophilia, serum-sickness-like syndrome, DRESS [Drug Reactions with Eosinophilia and Systemic Symptoms] syndrome, arthritis, vasculitis, and hepatitis). It has been postulated that minocycline may generate a specific reactive species that could be responsable for such reactions. Other effects include skin hyperpigmentation (particularly in areas exposed to the sun); single organ dysfunction (early onset, dose-related); Sweet syndrome; pseudotumour cerebri; and vestibular disturbances. In a review of minocycline efficacy and safety in acne, Garner et al. (2002) suggested that because of a lack of proven efficacy advantages over other agents, and an uncertain safety profile, there could be no justification in continuing to use minocycline as a first line therapy in acne, and in France, the national regulatory authority (AFSSAPS) now recommends that oral minocycline should be reserved as a second choice oral antibiotic in acne.


  • “European recommendations on the use of oral antibiotics for acne” EJD, vol. 14, n° 6, November-December 2004


These studies show that the use of antibiotic medication in the treatment of acne is only temporary and what’s worse is, it makes the acne bacteria more and more resistant to antibiotics when used for a long term period. It also identified the serious side effects of using antibiotics that can cause more harm than cure. This clearly means, one does not have to take a medication that can give more health risks without promising any lasting outcome.

Summary and Conclusion

After discussion of the characteristic, mode of action, therapeutic benefits, side effects, and special precautions in the use of Tetracycline, Minocycline and Erythromycin, do the advantages in its use for acne outweigh the disadvantages or is it the other way around, you be the judge!

Unlike Tetracycline and Minocycline that have the approval for use in the treatment of acne, Erythromycin is not included, but, is still being prescribed. So to a patient it is highly important to examine the medications being prescribed to you for acne treatment.

The trend today is towards health and wellness, that is why there are various available alternative supplements to help boost the immune system and nurture the good bacteria in the gut, which will give you an acne free skin and a healthy body. It could be the best option in the treatment of acne, especially if the products have been closely researched, undergone several clinical trials and have been carefully prepared. Lastly, a healthy immune system is still the best way to fight off any bacteria or virus for that matter.

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