Moderate-Severe Acne vulgaris - oral antibiotic advice

NICE Clinical Knowledge Summaries - Management of Acne vulgaris in primary care

Referral:

• Urgently refer people with acne fulminans 
• Refer people to dermatology if:
  • There is diagnostic uncertainty.
  • They have acne conglobata.
  • They have nodulo-cystic acne.
  • They are non-responsive following at least two completed courses of treatment

 

People with mild-moderate acne should NOT be treated with oral antibiotics.

 

Moderate-Severe acne:

If an oral antibiotic is being considered in combination with topical non-antibiotic agents for moderate-severe acne, the preferred option is:

DOXYCYCLINE 100mg OD 

(contraindicated during pregnancy and when planning a pregnancy)

 

Do not use the following to treat acne: 

• • Monotherapy with topical antibiotic.
  • Monotherapy with oral antibiotic.
  • A combination of topical antibiotic and oral antibiotic.

Oral antibiotic should not be prescribed in isolation due to the risk of selection of antibiotic resistant bacteria.

 

Lymecycline should only be used where there are potential issues with Doxycycline therapy e.g. intolerance, photosensitivity