Health Library Antibiotics for RosaceaFrom Healthwise

Oral antibiotics

Topical antibiotics

The ability of antibiotics to kill bacteria does not seem to be important when treating rosacea.¹ Instead, the antibiotics may reduce overall inflammation of your skin. They also may reduce the number of pimples and the amount of redness around pimples.

You can apply antibiotics directly to the skin (topically), or you can take them by mouth (orally). Oral and topical antibiotics may be used together or alone to treat rosacea.

Oral antibiotics also help treat eye problems caused by rosacea.

You can use antibiotics to reduce the symptoms of rosacea, including redness, pimples, and eye symptoms.

People with mild rosacea may only need antibiotic creams. Moderate or severe symptoms usually require oral antibiotics.

Treatment usually begins with an oral antibiotic, such as tetracycline, minocycline, or doxycycline, which is then gradually stopped when symptoms improve. Sometimes, a combination of oral and topical antibiotics is used. Long-term use of oral antibiotics may cause side effects. A controlled release form of doxycycline (Oracea) may be used for months or even years to control rosacea. This form of doxycycline is effective and causes fewer side effects than standard forms of doxycycline.²

Following treatment with oral antibiotics, the person continues treatment with a topical antibiotic, such as metronidazole. Studies have found that if red, raised bumps have developed, topical metronidazole (1%) is safe and effective. Metronidazole gel (0.75%) is effective in preventing or minimizing recurrences of rosacea.³

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 problems from rosacea.

Common side effects of oral antibiotics include:

• Nausea or vomiting.
• Diarrhea.
• Photosensitivity.
• Allergic reaction.
• Vaginal yeast infections.

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 that contains active cultures (lactobacillus) may help prevent some of these side effects.

A large study has shown that people who take erythromycin along with some common medicines, such as certain calcium channel blockers, antidepressants, and antifungal medicines, increase their risk of sudden heart-related death.⁴

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

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 antibiotics are not safe for pregnant women. Some of these antibiotics also lower the effectiveness of birth control pills.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

1. Del Rosso JQ (2007). Acne vulgaris and rosacea. In DC Dale, DD Federman, eds., ACP Medicine, section 2, chap. 12. New York: WebMD.

2. Del Rosso JQ, et al. (2007). Two randomized phase III clinical trials evaluating anti-inflammatory dose doxycycline (40-mg doxycycline, USP capsules) administered once daily for treatment of rosacea. Journal of the American Academy of Dermatology, 56(5): 791–802.

3. Wolff K, et al. (2005). Rosacea. In Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 5th ed., pp. 8–10. New York: McGraw-Hill.

4. Ray WA, et al. (2004). Oral erythromycin and the risk of sudden death from cardiac causes. New England Journal of Medicine, 351(11): 1089–1096.

Author:	Maria G. Essig, MS, ELS	Last Updated: July 24, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Alexander H. Murray, MD, FRCPC - Dermatology
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