According to guidelines from the AAD, systemic antibiotics are recommended in the management of moderate and severe acne and forms of inflammatory acne that are resistant to topical treatments. The guidelines also state that the use of oral erythromycin and azithromycin should be limited to patients who cannot use tetracyclines (ie, pregnant women or children younger than 8 years).
The AAD suggests that although doxycycline and minocycline are more effective than tetracycline, neither is considered superior to the other. They also state that trimethoprim-sulfamethoxazole and trimethoprim use should be restricted to patients who are unable to tolerate tetracyclines or in treatment-resistant patients.
The guidelines suggest that systemic antibiotic use in patients with acne should be limited to the shortest possible duration. Patients should be reevaluated at 3-4 months to minimize the development of bacterial resistance. The AAD does recommend concomitant topical therapy with benzoyl peroxide or a retinoid with systemic antibiotics and maintenance after completion of systemic antibiotic therapy.
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Cite this: William James. Fast Five Quiz: Acne Practice Essentials - Medscape - Jan 15, 2020.