Practice Change page

Don't use minocycline as first line oral antibiotic in acne

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39048.540394.BE (Published 18 January 2007) Cite this as: BMJ 2007;334:154
  1. Paul McManus, associate editor,
  2. Ike Iheanacho, editor
  1. 1 Drug and Therapeutics Bulletin, BMA House, London WC1H 9JR
  1. Correspondence to: P McManus PMcManus{at}bmjgroup.com

    Key points

    • Oral minocycline is no more effective than other oral tetracyclines in treating acne

    • The risk of rare but serious unwanted effects with minocycline makes it less suitable for use than other drugs in its class

    • Oral minocycline is more expensive than most other oral tetracyclines

    • Patients who need treatment with an oral tetracycline should be prescribed doxycycline, lymecycline, or oxytetracycline

    The clinical problem

    Most people develop acne vulgaris at some point in life. Typified by inflammation of hair follicles and accompanying sebaceous glands, acne may require oral antibacterial treatment, particularly in those with moderate to severe disease (an estimated 11% of adolescents1). Minocycline is a common choice of drug and is often wrongly assumed to be more effective, easier to take, and less likely to cause bacterial resistance than other tetracyclines.

    Search methods

    We searched Medline and the Cochrane Library to identify published randomised controlled trials and systematic reviews that assessed the safety and efficacy of oral minocycline in the treatment of acne vulgaris. We also consulted widely among specialists and generalists, as well as drug companies, to identify relevant published evidence.

    The evidence for change

    Efficacy

    A Cochrane review assessed 27 randomised trials, involving a total of 3031 patients with acne vulgaris affecting the …

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