Do Antibiotics Offer a Safe, Effective Way to Treat Acne?

Heap of medicine pills. Background made from colorful pills and capsules

Some antibiotics are effective at killing acne, but others just cause them to go dormant.

Acne antibiotics used to be the first thing the doctor would prescribe for pimples, but acne bacteria have developed resistance to many antibiotic treatments so that old medications don’t work, and the risk of complications from antibiotic treatment is real. Still, antibiotics can play an important role in getting rid of acne for some people—if they are used correctly. This article will tell you what you need to know about acne antibiotics that really work.


  • Antibiotics shut down the metabolic machinery of bacteria. Some antibiotics kill acne on contact, but others just cause them to go dormant.
  • Antibiotics are available as pills you take by mouth and as gels, lotions, creams, and serums you put on your face.
  • The antibiotic you used 10 years ago may no longer be effective, as acne bacteria develop antibiotic resistance.
  • American doctors often prescribe certain acne antibiotics to anyone over the age of 8 that European and Canadian doctors will not prescribe to anyone under the age of 22, because of the possibility of staining the teeth.
  • Some antibiotics can cause sensitivity to sun for users who have brown, black, or Asian skin types. Sun exposure without sunscreen can cause permanent spotting of the skin even when acne heals.
  • Antibiotics for acne can also cause sun sensitivity and brown skin spotting in women who take the contraceptive Pill.

Acne Antibiotics and Acne Bacteria

Acne bacteria are a normal fixture on healthy skin. In small numbers, they keep too much oily sebum from accumulating in pores. The bacteria feed on the long-chain fats in sebum, using part of the fat for food, and releasing skin-healthy n-3 essential fatty acids as a byproduct. These fats reduce inflammation in the skin, but they increase inflammation in bacteria. As soon as the bacteria finish eating excess sebum, their skin-healthy byproducts cause them to shut down and enter a hibernation cycle. Small numbers of acne bacteria are actually a good thing for the skin.

The problem with acne bacteria occurs when they get stuck in a pore underneath hardened skin oils. When the face is not washed properly, or when hormonal changes make skin tight, or when the skin produces extra oil to deal with stress or inflammation, acne bacteria can get trapped in the skin. These bacteria release chemicals that let them out—by making surrounding skin more sensitive to the immune system. It is actually the immune system that causes the redness, irritation, inflammation, and itching of pimples, not bacteria. But killing bacteria stops the process that keeps the immune system on red alert.

Antibiotics alone have a harder time getting rid of acne today due to antibiotic resistance.

Antibiotics alone have a harder time getting rid of acne today due to antibiotic resistance.

Antibiotics kill bacteria by interfering with their ability to make proteins. Some of the older antibiotics for acne, such as tetracycline, were bactericidal, that is, they killed bacteria on contact. Some of the newer antibiotics for acne, such as azithromycin, are bacteriostatic, that is, they force bacteria into hibernation. The problem with any kind of bacterial treatment is that some individual acne bacteria area likely to have the ability to resist it. They pass this ability on to their descendants, and they can also exchange genetic material with nearby bacteria to make them resistant, too. Antibiotics by themselves are usually not enough in this era of antibiotic resistance.

If most of your blemishes are in the form of blackheads and whiteheads then antibiotics probably aren’t needed and won’t do much, if any good. Use a topical treatment that unclogs pores instead. If there’s a mixture of whiteheads, blackheads and inflammatory pimples, then a combination of antibiotics and a topical treatment like benzoyl peroxide may be recommended. A complete acne kit that treats acne from all angles, like Exposed Skin Care, may be an easier, less-expensive option too.

Minimizing Risk of Antibiotic Resistance

If you’re prescribed oral antibiotics, your doctor will probably start with a higher dose and decrease the dosing over time. They’ll also want to start tapering off of them when either your skin starts to improve or it’s obvious they aren’t doing anything and probably aren’t going to work. This normally will happen several months into treatment. By tapering off of them, you reduce the risk of antibiotic resistance by not using more than needed or for long periods.

Your doctor will also probably recommend the use of topical medications, too. Research shows that the use of benzoyl peroxide, in addition to oral antibiotics, can also minimize the risk of resistance.

Acne Antibiotics that Work, and Acne Antibiotics That Don’t

Acne antibiotics are offered in pill form, and as antibiotic lotions and creams. Some options for treating acne with antibiotics include:

  • Substances that kill acne bacteria by inflammation, such as benzoyl peroxide, oil of cloves, and chlorhexidine gluconate. Bacteria don’t develop resistance to these treatments, but they don’t kill as many bacteria, either.
  • Tetracycline and related antibiotics, such as Sumycin. These drugs are eliminated from the bloodstream in about 12 hours. Many strains of acne bacteria have become resistant to Sumycin. This drug and other tetracycline antibiotics can cause staining of the teeth in users up to the age of 22.
  • Minocycline, sold under the trade names Minacin and Dyancin (as well as many others). This antibiotic stays in the bloodstream for about 48 hours. It’s often used to treat acne that hasn’t responded to other antibiotics and is ideal for pustular acne. It also can stain teeth in users as old as 22.
  • Doxycycline, sold under the trade name Vibramycin. This antibiotic is preferred in Canada and Europe because it won’t stain teeth. It fights acne bacteria, but it has no effect on staph bacteria, the microorganisms that can cause pus-filled “pimples” with yellow circles in the center. It’s best used for inflammatory acne. It also increases sensitivity to sunlight, and may increase the likelihood of brown spots on the skin after acne has healed, especially for people who have Asian skin types.
  • Trimethoprim/sulfamethoxazole, marketed under the trade names Bactrim and Septra. This product won’t fight resistant acne bacteria and it can cause brown skin spotting in women who use both this antibiotic and oral contraceptives.
  • Azithromycin (Zithromax) is offered when other treatments don’t stop resistant bacteria. Certain other fluoroquinolone antibiotics such as ciprofloxacin (Cipro) and levofloxacin (Levaquin) may be prescribed when there are multiple infections of the skin—don’t drink orange juice or grapefruit juice or eat oranges or grapefruit if you take Cipro or Levaquin.
  • Erythromycin is an antibiotic that’s been used for years and can help clear acne, but it isn’t the most effective (largely due to antibiotic resistance). However, it is often recommended during pregnancy or if you’re breastfeeding. It is also one of the few that both adults and kids can take – and won’t cause staining of the teeth.

If you live in the United States, you probably want to have a discussion with your doctor about the possibility of staining your teeth if you are offered a prescription for Minacin (minocycline) or any form of tetracycline (now sold as a generic). If you have brown, black, or Asian skin, or if you are on the Pill, you will need to use at least SPF-15 sunscreen to protect your skin from spotting if you use any antibiotics.

Allergic reactions may occur with certain antibiotics.

Allergic reactions may occur with certain antibiotics.

Antibiotics can also cause deficiencies of the B vitamin folic acid. North Americans get lots of folic acid from fortified wheat flour, but people in the rest of the world who take oral antibiotics for acne may need to take a supplement providing at least the recommended daily intake (available even in the European Union).

You should tell your doctor if you’ve ever taken an antibiotic and had a bad reaction to it. Those who are susceptible to bad reactions and allergies can often develop rashes when using oral antibiotics. While an allergic reaction to erythromycin or tetracycline are not common, there are some antibiotics that are known for being troublesome. More than 2% of cotrimoxazole and trimethorprim users end up allergic to them.

Don’t expect antibiotics to magically clear your acne in a few days. It will probably be at least four weeks before you start to see noticeable improvement, but before seeing the maximum results it could easily be four months. So don’t stop using it because your skin isn’t clearing a week or two into the treatment. One of the main reasons treatments don’t work is the user thinks it isn’t working, gives up and stops using it.

Topical Antibiotics

The topical antibiotics most often used to treat acne include clindamycin and erythromycin and often are paired with benzoyl peroxide. Topical antibiotics do not carry the risk of as many side effects as oral antibiotics, but they still need to be used with care. Here are some practical suggestions for success with topical antibiotic treatment for acne:

  • Antibiotic creams and lotions are usually less irritating than antibiotic gels or serums.
  • Antibiotics do not break up whiteheads or blackheads. If you use an antibiotic gel, cream, or lotion, you still need to do regular cleansing and exfoliation of the skin.
  • Bacteria can develop resistance to antibiotic creams, lotions, gels, and serums. These medications can leave a few especially tough bacteria behind. Since they do not have any competition for food, they can grow to cause a hard-to-treat infection of the skin, unless you kill them, too. Using antibacterial products like benzoyl peroxide, chlorhexidine gluconate, and/or oil of cloves on your skin can kill these last few bacteria and keep your skin clear.

It’s always a good idea to do a patch test before you apply any product to your face. Place a dot of the antibiotic or antibacterial product on the skin of your forearm, and leave it for 8 hours. If there is no irritation on your arm, then it is probably safe to use the product on your face.

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