Oral and Topical Antibiotics

Antibiotics may reduce overall inflammation of your skin. Antibiotics also reduce the number of pimples and the amount of redness around pimples.

Antibiotics can be applied directly to the skin (topically) or taken by mouth (orally). Topical antibiotics kill bacteria that are on the skin. Oral antibiotics kill bacteria in the skin pores, and work best if started at high doses. When symptoms improve, the dose is then tapered off and a topical antibiotic is used.

Antibiotics are used to reduce the symptoms of rosacea, including redness, pimples, and red lines on the face (telangiectasia), and thick bumps on the nose (rhinophyma), and to reduce the symptoms that accompany eye involvement in rosacea.

People with mild rosacea may only need topical antibiotics. Moderate or severe symptoms usually require oral antibiotics.

To treat rosacea, a typical course of antibiotics would begin with an oral antibiotic, such as tetracycline. Oral antibiotics are usually tapered off after symptoms improve because long-term use of oral antibiotics is associated with side effects. Bacteria build immunity to topical and oral antibiotics within 3 to 5 months, therefore they lose their effectiveness. A topical antibiotic is then used, such as metronidazole. Studies have found that if red, raised bumps have developed, topical metronidazole (1%) is safe and effective. Metronidazole gel (.75%) is effective in preventing or minimizing recurrences of rosacea.

With antibiotic treatment, symptoms usually improve in 3 to 4 weeks, with greater improvement seen in 2 months.

Oral antibiotics, such as tetracycline, are often used with good results to treat eye involvement in rosacea.

Common side effects of antibiotics include:

• Nausea or vomiting
• Diarrhea
• Photosensitivity
• Allergic reaction
• Vaginal yeast infection

Diarrhea and vaginal yeast infections may occur when oral antibiotics destroy some of the normal and necessary bacteria that live in the body. Eating yogurt may help prevent some of these side effects.

See Drug Reference Lists or package inserts for a full list of side effects.

Many public health experts are concerned about antibiotic resistance, a problem that can develop when antibiotics are overused. Over time, bacteria develop new defenses against antibiotics that once were effective against them. Bacteria reproduce so quickly, these defenses can be rapidly passed on through generations of bacteria until almost all are immune to the effects of a particular antibiotic. The process happens faster than new antibiotics can be developed. To help control the problem, many experts advise people to use antibiotics only for short periods, and only as directed. An antibiotic that works for one person with rosacea may not work for another. Over time, antibiotics can stop being effective. When this occurs, a different antibiotic may be used.

Some of the more common topical and oral antibiotics prescribed to treat symptoms related to rosacea are listed below.

Used on the skin to treat acne. Sold under the Brand Name(s):

• Erymax®
• Erygel®
• A/T/S®
• Staticin®
• Erycette®
• Ery-Sol®
• Erythra-Derm®
• T-Stat®
• Eryderm®

You should not use this medicine if you have ever had an allergic reaction to erythromycin.

Warnings:
If you are pregnant or breastfeeding, talk to your doctor before using this medicine.

Side effects:
If you have problems with these less serious side effects, tell your doctor.

• Skin rash, redness, swelling or itching
• Dry or peeling skin
• Tenderness, stinging or burning
• Eye irritation

Treats infections. Sold under the Brand Name(s):

• Robimycin®
• Eryc®
• E.E.S.®
• E-Mycin®
• Erythrocin® (Oral)
• Pediamycin®
• Ilosone®

You should not use this medicine if you have had an allergic reaction to any type of erythromycin. Ask your doctor or pharmacist before using any other medicine, including over the-counter medicines, vitamins, and herbal products. Make sure your doctor knows if you are taking theophylline, Seldane®, blood thinners such as Coumadin®, or seizure medicines such as Dilantin® or Tegretol®.

Warnings:

• If you are pregnant or breastfeeding, talk to your doctor before taking this medicine. Contact your doctor right away if you develop a skin rash or itching while taking this medicine.
• Make sure your doctor knows if you have liver or kidney disease.

Side effects:
Call your doctor right away if you have any of these side effects:

• Skin rash, hives or itching
• Difficulty breathing
• Swelling of the face, throat, or lips

If you have problems with these less serious side effects, talk to your doctor.

• Nausea or upset stomach
• Diarrhea
• Sore mouth or tongue

Treats skin redness and pimples caused by a skin condition called rosacea (adult acne, or acne rosacea). Sold under the Brand Name(s):

• Metrogel®
• Metrocream(Tm)
• Noritate®

You should not use this medicine if you have had an allergic reaction to metronidazole. Use this medicine on your skin only. You should not use the medicine in or near your eyes. The medicine may make your eyes water if it is put on areas around your eyes. If you do get the medicine in your eyes, rinse them well with cool water. Tell your doctor if redness or eye pain does not go away.

Treats acne and skin infections. Sold under the Brand Name(s):

• Cleocin-T Lotion® (Topical)
• Cleocin-T Topical Solution® (Topical)
• Cleocin-T Gel® (Topical)

You should not use this medicine if you have had an allergic reaction to Cleocin® or Lincocin® or if you have had an intestinal or stomach disease. Ask your doctor or pharmacist before taking any other medicine, including over-the-counter medicines, vitamins, and herbal products. If your doctor has prescribed other medicines to be used on your skin, use them at a different time than clindamycin. Some cosmetics or make-ups may cause your acne to get worse. They may also cause clindamycin to irritate your skin. Use water-based cosmetics.

Warnings:
If you are pregnant or breastfeeding, talk to your doctor before using this medicine.

Side effects:
Call your doctor right away if you have any of these side effects:

• Hives or rash
• Swelling of the face, throat, or lips
• Severe diarrhea (watery or bloody)

If you have problems with these less serious side effects, talk with your doctor.

• Dryness or peeling of skin
• Irritation or burning of skin

Treats eye infections. Belongs to a class of drugs called sulfonamide antibiotics. Sold under the Brand Name(s):

• Isopto-Cetamide®
• Sulfair®
• Ak-Sulf®
• Ophthacet®
• Cetamide®
• Sulf-10®
• Sulfair Forte®
• Sodium Sulamyd®
• Sulten-10®

You should not use this medicine if you have had an allergic reaction to sulfacetamide or other sulfa medicines. Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

Warnings:
If you are pregnant or breastfeeding, talk to your doctor before using this medicine.

Side effects:
Call your doctor right away if you have any of these side effects:

• Vision changes
• Severe eye irritation that was not there before using this medicine

If you have problems with these less serious side effects, talk with your doctor.

• Watery eyes
• Redness, itching, burning, or stinging of the eyes

This medication is used to treat acne. Sold under the common brand name Klaron.

Side Effects:

• Irritation, stinging or burning of the skin may occur. If these effects persist or worsen, notify your doctor promptly.
• Unlikely but report promptly severe redness or scaling of the skin or muscle/joint aches.
• In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention.
• Symptoms of an allergic reaction include rash, itching, swelling, dizziness, unusual tiredness, yellowing of the skin or eyes, stomach pain, nausea, persistent fever or trouble breathing.

If you notice other effects not listed above, contact your doctor or pharmacist.

Precautions:

• Tell your doctor your medical history, including any allergies (especially to other sulfa drugs such as sulfamethoxazole or to sulfites) or asthma.
• Use of this medication for prolonged or repeated periods may result in a secondary infection (e.g., affecting the skin). Consult your doctor or pharmacist.
• This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.
• It is not known whether this drug is excreted into breast milk. Consult your doctor before breast-feeding.

Treats infections. Sold under the Brand Name(s):

• Panmycin®
• Tetracyn®
• Robitet®
• Achromycin V®
• Sumycin®

You should not use this medicine if you have ever had an allergic reaction to any tetracycline medicine. Do not give this medicine to children under 8 years old because it can permanently change tooth color. You should not use tetracycline if you are pregnant, breastfeeding, or have liver disease. Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products. Do not eat dairy products (such as milk, cheese, yogurt, or ice cream) within 1 to 2 hours before or after taking tetracycline. You should not use antacids, calcium or iron supplements, sodium bicarbonate (Alka-Seltzer®, baking soda), colestipol (Colestid®), or cholestyramine (Questran®) at the same time you take tetracycline. Birth control pills may not work while you are taking tetracycline. Use other forms of birth control while you are taking this medicine.

Warnings:

• Tetracycline increases the chances of a sun burn. Wear sunscreen if you are in the sun while taking this medicine.
• You should not use this medicine during the last half of pregnancy or while you are breastfeeding.
• Throw away unused tetracycline after the expiration date. It can be harmful.

Side effects:
Call your doctor right away if you have any of these side effects:

• Rash, hives, severe itching, swelling
• Wheezing, trouble breathing
• Severe diarrhea (watery or bloody)
• Blistering or peeling skin

If you have problems with these less serious side effects, talk with your doctor.

• Mild diarrhea
• Nausea, upset stomach
• Sensitivity to sunlight
• Vaginal itching or discharge

Treats infections. Sold under the Brand Name(s):

• Vibra-Tabs®
• Vibramycin®
• Monodox®
• Doryx®
• Novodoxylin®

You should not use doxycycline if you have ever had an allergic reaction to any tetracycline. Do not give this medicine to children under 8 years old because it can permanently change tooth color. You should not use this medicine if you are pregnant or breastfeeding. Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products. Avoid taking the following medicines at the same time (within 2 hours) as doxycycline: antacids such as Maalox® or Mylanta®, calcium or iron supplements, cholestyramine (Questran®), or cholestipol (Colestid®). Birth control pills may not work as well while taking doxycycline. Use other forms of birth control while you are taking this medicine.

Warnings:

• If you have liver disease or if you are pregnant or breastfeeding, talk to your doctor before taking this medicine.
• Doxycycline increases the chance of sunburn. Protect your skin with sunscreen and clothing if you are in the sun.

Side effects:
Call your doctor right away if you have any of these side effects:

• Skin rash, hives, or itching
• Wheezing or trouble breathing
• Swelling of the face, lips, or throat

If you have problems with these less serious side effects, talk with your doctor:

• Diarrhea
• Nausea or upset stomach
• Sore mouth or throat
• Sensitivity to sunlight
• Itching of the mouth or vagina that lasts for more than 2 days

Treats infections that are caused by bacteria. Belongs to a class of drugs called tetracycline antibiotics. Sold under the Brand Name(s):

• Minocin® (Oral)
• Dynacin®

You should not use this medicine if you have ever had an allergic reaction to any tetracycline medicine or if you have sulfite sensitivity. Do not give this medicine to children under 8 years old because it can permanently change tooth color. You should not use this medicine if you are pregnant or breastfeeding. Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products. Make sure your doctor knows if you are taking any other antibiotics, or blood thinners like Coumadin®. You should not use antacids or iron supplements while you are taking minocycline. Birth control pills may not work while you are taking minocycline. You may need to use other forms of birth control while you are taking this medicine. If you have questions about this, ask your doctor, nurse, or pharmacist. Before having any surgery or procedures that require general anesthesia, tell the doctor in charge that you are taking this medicine.

Warnings:

• Check with your doctor before taking this medicine if you have kidney disease or liver disease.
• If you are pregnant or breastfeeding, talk to your doctor before taking this medicine.
• This medicine may make you dizzy or lightheaded. Avoid driving a car or using machinery until you know how this medicine will affect you.
• This medicine may cause your skin to be more sensitive to sunlight. Your doctor may tell you to avoid direct sunlight and not to use tanning beds. If your skin becomes sunburned, you may need to stop taking this medicine.

Side effects:
Call your doctor right away if you have any of these side effects:

• Allergic reaction: Itching or hives, swelling in face or hands, swelling or tingling in the mouth or throat, tightness in chest, trouble breathing
• Headache or blurred vision
• Sore throat, heartburn, or pain behind your breastbone
• Severe skin rash or sores
• Stomach pain (severe)

If you have problems with these less serious side effects, talk with your doctor:

• Dizziness or lightheadedness
• Nausea, vomiting, or diarrhea
• Problems with hearing
• Skin rash

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