13.6.2 Oral preparations for acne
|1st choice||Lymecycline capsules 408mg||Dose: 408mg daily|
|2nd choice||Doxycycline capsules 100mg||Dose: 100mg daily|
|Erythromycin tablets 250mg||Dose: 500mg twice daily|
- Avoid concomitant treatment with different oral and topical antibacterials to reduce the likelihood of development of bacterial resistance. As a general rule if an oral antibiotic is prescribed there is no need to continue the topical antibacterial therapy.
- The use of topical benzoyl peroxide should be considered when prescribing an oral antibiotic for acne in order to help reduce the development of resistance.
- Oral antibacterial treatment for acne should be reviewed after 3 months.
- Switch to an alternative antibiotic if no response after 3 months.
- Doxycycline can cause photosensitivity in some patients.
- Tetracyclines must be avoided in pregnancy.
- COCs are recommended as a first line adjunctive treatment for women who have acne. The evidence shows few differences between different types of COCs (including co-cyprindiol) but progesterone only contraceptives may worsen acne. See section 7.3.1 for COC choices.
- Co-cyprindiol 2000/35 is a treatment for severe acne refractory to prolonged antibiotic therapy. Only in those patients may it also be used as an oral contraceptive see section 7.3.1 for further details.
- If a patient does not respond to first or second line oral therapy, after an appropriate therapeutic trial of 3-6 months, a referral to dermatology is appropriate. Oral isotretinoin (Roaccutane®) is a teratogenic drug which is only prescribable by a consultant dermatologist. For this reason, oral isotretinoin is a RED list medication in Northern Ireland.