Managing Expectations and Educating Patients on Limited Antibiotic Use

EP: 1.Evolving Acne Management

EP: 2.The Role of Guidelines, Patients, and Payers in Acne Management

EP: 3.Selecting Patients for Oral Antibiotic Therapy

EP: 4.Exploring the Anti-Inflammatory Impact of Oral Antibiotics

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EP: 5.Managing Expectations and Educating Patients on Limited Antibiotic Use

EP: 6.Approach to Selecting and Managing Oral Antibiotics in Acne Care

When discussing oral antibiotic therapy with patients, it’s essential to clearly outline the expected timeline and therapeutic goals. The typical plan involves a 3- to 6-month course, intended not as a long-term solution, but as a short-term intervention to reduce inflammation and gain control over acne quickly. This approach is almost always paired with topical therapies, such as a retinoid and a second agent such as dapsone or a fixed-dose combination product. The goal is to stabilize the condition and then taper the oral antibiotic, maintaining results with topicals alone. This phased strategy is part of responsible antibiotic stewardship and ensures patients are aligned with a sustainable, long-term plan.

Choosing the right oral antibiotic also involves nuanced decision-making, particularly in differentiating between broad- and narrow-spectrum options. Among tetracyclines—doxycycline, minocycline, and sarecycline—clinical efficacy is generally comparable by week 12. However, each comes with distinct adverse effect profiles. Doxycycline, for instance, is often associated with gastrointestinal upset and sun sensitivity, making it less ideal in certain seasons or for outdoor-active teens. Minocycline may trigger vestibular disturbances such as dizziness, a concern serious enough to preclude its use in U.S. military aviators. In contrast, sarecycline, a narrow-spectrum antibiotic, stands out for having fewer systemic adverse effects, reduced gut microbiome disruption, and minimal risk of photosensitivity or vestibular issues.

When patients are educated on these differences—particularly the safety and tolerability advantages of narrow-spectrum agents—they tend to be more accepting, even if that means a higher out-of-pocket cost for branded options such as sarecycline. That said, access and affordability remain practical limitations. This is why it’s critical for clinicians to be familiar with all available antibiotics and tailor choices based on both clinical need and patient-specific factors. When feasible, start with a narrow-spectrum agent that supports antibiotic stewardship and aligns with CDC recommendations to reduce the risk of resistance.