Acne Vulgaris - Antibiotic Prescribing

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC). See guidance on dosing in children for quick reference dosage/weight guide. Refer to drug interactions table for detailed drug interactions for all antimicrobials. Note extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.

Note additional warnings for clarithromycin and fluoroquinolones

Panton-Valentine Leukocidin (PVL) is a toxin produced by 2% of Staphylococcus aureus and is associated with persistent recurrent pustules and carbuncles or cellulitis. Send swabs for culture in these clinical scenarios. On rare occasions it causes more severe invasive infections, even in otherwise fit people. Risk factors include: nursing homes, contact sports, sharing equipment, poor hygiene and eczema.


Comments from Expert Advisory Committee

  • Topical treatment first line e.g. benzoyl peroxide gel, retinoid or topical antibiotic.
  • Avoid using topical and oral antibiotics concurrently. However, topical benzoyl peroxide gel with oral antibiotic reduces risk of antibiotic resistance.

Treatment

Treatment Dose TX Duration
doxycycline 100mg OD Review in 3 months, but may take 4-6 months
OR lymecycline 408mg OD
(OR trimethoprim in tetracycline resistance) 300mg BD

For severe acne in pregnancy, seeks specialist advice.


Acne

Topical treatments should include, benzoyl peroxide, topical retinoids (non-pregnant), or topical antibiotic combined with a drying agent.
Do not use topical and oral antibiotics together (increases resistance).

  • Lymecycline 408mgs (300mgs) od 3-6 months
  • Doxycycline 100mgs od 3-6 months
  • Minocycline SA 100mgs od 3-6 months

(advise of abnormal LFT’s, irreversible cutaneous pigmentation and reversible drug induced lupus).

  • Trimethoprim 200mgs bd increasing to 300mgs bd 3-6months.

(caution re Stevens Johnson syndrome/ Toxic epidermal necrolysis)

(Consider tertiary referral for Roaccutane if 2 different antibiotic courses failed to treat or nodulocystic acne).

  • Erythromycin has high levels of resistance and is not effective for acne.

References

  • Humphrey S.Antibiotic resistance in acne treatment. Skin Therapy letter. 2012; 17.
  • Sardana K, Garg.V.Antibiotic resistance in acne. Is it time to look beyond antibiotics and Propionobacterium acnes? International Journal of Dermatology 2014;53:917-919.

Patient Information

We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

The HSE Health A-Z website provides patient information on many hundreds of conditions and treatments.

Click here to view information on Acne


ICGP Report: Acne Management in Primary Care

Acne ICGP Report 2016

Acne Management in Primary Care, ICGP 2016, Dr Johnny Loughnane, GP

Reviewed Nov 2017