title: Oral Antibacterial Therapy for Acne Vulgaris: An Evidence-Based Review.
abstract: BACKGROUND
  To some degree, acne vulgaris affects nearly every individual worldwide. Oral antibiotic therapy is routinely prescribed for the treatment of moderate to severe inflammatory acne; however, long-term use of oral antibiotics for acne may have unintended consequences.
  
  
  OBJECTIVE
  The aim of this study was to provide a systematic evaluation of the scientific evidence on the efficacy and appropriate use of oral antibiotics in the treatment of acne.
  
  
  METHODS
  A systematic search of MEDLINE was conducted to identify randomized controlled clinical trials, systematic reviews, and meta-analyses evaluating the efficacy of oral antibiotics for acne. Overall, 41 articles that examined oral antibiotics compared with placebo, another oral therapy, topical therapy, alternate dose, or duration were included in this study.
  
  
  RESULTS
  Tetracyclines, macrolides, and trimethoprim/sulfamethoxazole are effective and safe in the treatment of moderate to severe inflammatory acne. Superior efficacy of one type or class of antibiotic could not be determined, therefore the choice of antibiotic is generally based on the side-effect profile. Although different dosing regimens have been studied, there is a lack of standardized comparator trials to determine optimal dosing and duration of each oral antibiotic used in acne. The combination of oral antibiotics with a topical therapy is superior to oral antibiotics alone.
  
  
  CONCLUSIONS
  This article provides a systematic evaluation of the scientific evidence of the efficacy of oral antibiotics for acne. Due to heterogeneity in the design of the trials, there is insufficient evidence to support one type, dose, or duration of oral antibiotic over another in terms of efficacy; however, due to increasing resistance to antibiotics, dermatologists should heed consensus guidelines for their appropriate use.
authors.affiliation: New York University School of Medicine, New York, NY, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Bienenfeld
authors.affiliation: The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA.
authors.forename: Arielle R
authors.initials: AR
authors.lastname: Nagler
authors.affiliation: The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA. Seth.Orlow@nyumc.org.
authors.forename: Seth J
authors.initials: SJ
authors.lastname: Orlow
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy*; D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004318:Doxycycline / Q000008:administration & dosage; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D006801:Humans; D015201:Meta-Analysis as Topic; D008911:Minocycline / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D013754:Tetracyclines / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D013754:Tetracyclines; D008911:Minocycline; D004318:Doxycycline