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Oral and Topical Antibiotics

Treating Rosacea with 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.

Erythromycin (Topical)

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

Erythromycin (Oral)

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
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