Acne is common, but is usually treatable. You need treatment for several months to clear spots. This leaflet describes the treatment of acne with antibiotic tablets. There are separate leaflets that describe other treatments for acne. There is also a general leaflet about acne.

Antibiotics and how they work in acne

Antibiotics work by killing bacteria that contribute to the cause of acne. They also have a direct effect of reducing inflammation. Antibiotics usually work well to clear or reduce acne spots, and any surrounding redness (inflammation).

However, antibiotics have little effect on unplugging blocked pores (which you can see as blackheads and whiteheads). So, if you only have mild acne with just blackheads and whiteheads, you are better off using a topical treatment (cream, gel, 'rub-on' etc) which unblocks pores. If you have a lot of blackheads and whiteheads as well as inflamed acne spots, you may be advised to use a topical treatment in addition to an antibiotic tablet.

Always read the leaflet that is in the packet of antibiotics. Things such as precautions and possible side-effects vary between different antibiotics. The following are some general points.

Oxytetracycline or tetracycline are the most commonly used antibiotics to treat acne. The usual dose is 500mg twice a day. An initial course of 3 months is usual.

Food and milk affects the absorption of these antibiotics. So, take the tablets on an 'empty stomach', between meals, with a glass of water, (not milk).
Children under 12 years should not take these antibiotics.
Do not take these antibiotics if you are pregnant, breastfeeding, or intend to become pregnant. Discuss contraception with your doctor if necessary.
Women taking oral contraceptives ('the pill') should take additional contraceptive precautions (such as condoms) during the first 2 weeks of taking these antibiotics.

Other antibiotics which are sometimes used include: doxycycline, erythromycin, and minocycline. These may be advised if one of the above has not worked well, or is unsuitable.

How long is treatment needed for?

it is normal to take 4-6 weeks to see any improvement, and up to 3 to 6 months for maximum effect. The most common reason why a treatment for acne fails is because some people think that treatment is not working after a few weeks, and give up.

It takes time to un-block pores and for any skin inflammation to settle. So, persevere with any treatment for several weeks. If there is no improvement after 2 months of taking or applying a treatment regularly and correctly, do not despair. A change to a different antibiotic, or to a more powerful treatment, is likely to work.

Once the spots have cleared, acne commonly flares up again if you stop treatment. So, after the spots have gone, you will usually be advised to carry on with a treatment to prevent acne from flaring up again. This is often a topical preparation which you apply to affected areas of skin (for example, benzoyl peroxide). You may need treatment for several years to keep acne away.

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