Antibiotics are prescribed for moderate-to-severe inflammatory acne — the kind characterised by red, swollen papules, pustules, and sometimes deeper nodules. They are not effective for non-inflammatory acne such as blackheads and whiteheads alone.
Oral Antibiotics Prescribed in the UK
Lymecycline (Tetralysal)
The most commonly prescribed first-line oral antibiotic for acne in the UK. Taken as a 408 mg capsule once daily, it is well tolerated and effective for most patients.
Doxycycline
An alternative tetracycline, usually prescribed at 100 mg once daily. Doxycycline is often chosen when lymecycline is unavailable or not tolerated. It carries a slightly higher risk of photosensitivity and oesophageal irritation.
Erythromycin
A macrolide antibiotic reserved for patients who cannot take tetracyclines, such as pregnant women or children under 12. Resistance to erythromycin is increasingly common, limiting its usefulness.
Topical Antibiotics
Clindamycin is the main topical antibiotic used for acne in the UK. It is never prescribed alone due to resistance concerns — instead, it is combined with benzoyl peroxide (as in Duac) or with tretinoin.
Antibiotic Resistance: A Growing Concern
UK prescribing guidelines from NICE (National Institute for Health and Care Excellence) are clear:
- Oral antibiotics should be limited to a maximum of 12 weeks.
- They should always be co-prescribed with a topical retinoid or benzoyl peroxide.
- Topical antibiotics must not be used as monotherapy.
- Do not combine oral and topical antibiotics.
These measures are designed to slow the development of antibiotic-resistant bacteria, which is a significant public health priority.
What Happens After Antibiotics?
Once the antibiotic course ends, maintenance therapy with a topical retinoid or azelaic acid is recommended to prevent relapse. If acne returns despite repeated antibiotic courses, your GP may refer you to a dermatologist to discuss options such as isotretinoin (Roaccutane).
Antibiotics are a valuable tool, but they work best as part of a broader treatment plan rather than a standalone solution.