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Acne Antibiotics
Published in Sarah H. Wakelin, Howard I. Maibach, Clive B. Archer, Handbook of Systemic Drug Treatment in Dermatology, 2015
Alexander Nast, Ricardo N. Werner
Antibiotics work relatively slowly in acne and it may improve adherence if patients are advised accordingly. The initial duration of therapy is 2–3 months. If there is no improvement after this time, another drug should be considered. Maximum improvement does not usually occur until after 4–6 months. In more severe cases, oral medication may need to be continued for 2 years or more. As acne is a chronic complaint, once inflammatory lesions have resolved, maintenance topical treatment should be prescribed (retinoids and/or benzoyl peroxide or azelaic acid). First choice treatment:Doxycycline: 100 mg once daily. (or 50mg–200mg daily)Lymecycline: 408 mg once daily.Tetracycline and oxytetracycline: 500 mg twice daily.Second choice treatment:Minocycline: 100 mg once daily.Third choice treatment:Trimethoprim: 300 mg twice daily (unlicensed use).During pregnancy and lactation:Erythromycin: 500 mg twice daily (not erythromycin estolate). Although all tetracyclines appear to have comparable efficacy against inflammatory acne lesions, lymecycline and doxycycline are preferred due to their lack of interaction with milk and once-daily dosage. Due to the risk of irreversible pigmentation and other adverse effects with minocycline, it should not be used as a first-line therapy. Published trials show a trend towards superior efficacy for tetracyclines compared with macrolides. Trimethoprim is unlicensed for the treatment of acne, and therefore considered a third choice antibiotic to be used under specialist recommendation.
Current treatment options for Mycobacterium marinum cutaneous infections
Published in Expert Opinion on Pharmacotherapy, 2023
Marina Medel-Plaza, Jaime Esteban
In summary, both minocycline as monotherapy and in combination with other drugs have proven to be good options for the treatment of M. marinum skin infections [4,34,44,48], however, failures due to therapeutic ineffectiveness or adverse effects have also been reported [16,35,64]. Brown-Elliott et al. [28] found that eravacycline had an MIC50 of 1 μg/ml, so it would have comparable susceptibility to doxycycline and minocycline and could be another option among the tetracyclines for the treatment of M. marinum and other NTM. Besides, Neugebauer et al [76] successfully treated a patient with another cyclin, lymecycline, and propose it as a new tool to include in the therapeutic arsenal for M. marinum nodular skin infections, but it is the only published case using this drug, so more studies are needed to confirm its efficacy.
Emerging drugs for the treatment of acne: a review of phase 2 & 3 trials
Published in Expert Opinion on Emerging Drugs, 2022
Siddharth Bhatt, Rohit Kothari, Durga Madhab Tripathy, Sunmeet Sandhu, Mahsa Babaei, Mohamad Goldust
Oral tetracyclines are used as the first-line therapy in non-pregnant adults and children > 8 years of age for management of moderate acne. It works by inhibiting protein synthesis by binding to the 30S subunit of the bacterial ribosome. This class has additional important anti-inflammatory effects including inhibition of chemotaxis and metalloproteinase activity, which are utilized in inflammatory acne. Drugs from this group are doxycycline, minocycline and Lymecycline. Minocycline in an extended-release form is the safest (at 1 mg/kg). Doxycycline is effective in the 1.7 to 2.4 mg/kg range but sub-antimicrobial dosing of doxycycline (20 mg twice daily to 40 mg daily) has also shown efficacy in patients with moderate inflammatory acne. Current studies indicate that minocycline is not more effective than doxycycline and has a worse side effect profile as compared to doxycycline [2]. Oral antibiotic therapy with various tetracyclines usually requires at least 3 weeks before initial visible improvement, and should not be given beyond 3 months to avoid bacterial resistance [3]. Side effects include pill esophagitis due to doxycycline and pigmentation due to minocycline. Serious side effects include pseudotumor cerebri and lupus erythematosus induction by minocycline [4].
Treatment challenges in adult female acne and future directions
Published in Expert Review of Clinical Pharmacology, 2021
Edileia Bagatin, Marco Alexandre Dias da Rocha, Thais Helena Proença Freitas, Caroline Sousa Costa
Second-generation tetracyclines – minocycline, doxycycline, and lymecycline – are nowadays the mainstay when opting for systemic antibiotic [80]. Macrolides represent a second-line for inflammatory acne due to increasing antimicrobial resistance [87,89]. Trimethoprim/sulfamethoxazole emerges as a third-line, when intolerance to tetracyclines or antibiotic-resistance occurs [82,87]. There is not a definitive and consistent body of evidence pointing out a greater efficacy of minocycline, doxycycline, and lymecycline when compared to tetracycline, either a superiority of one of them against the other two [82,90]. Advantages in comparison to tetracycline are chiefly related to the better pharmacokinetics: feeding does not impair their intestinal absorption, so they can be administered during meals; better adherence is related to single daily-dose regimen as these drugs have a longer half-life [91].