Antibiotics are the most common systemic agent prescribed for the treatment of acne, employed for their antibacterial and anti-inflammatory effect. Prolonged antibiotic courses can lead to disruption of the normal microbiome, increased rates of upper respiratory infection and has been linked to the development of other systemic disorders. There are also rising rates of antibiotic resistance to pathogenic acne bacteria. For moderate or more severe acne warranting systemic treatment, the effect of oral antibiotics should be reassessed after 3 months to gauge progress. If ineffective, treatment should be modified to other systemic medications such as anti-androgens (spironolactone), combined oral contraceptive pills or retinoids. Use of oral antibiotics should always be combined with topical benzoyl peroxide and/or a topical retinoid. For more information:
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