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

doi:10.1136/bmj.39048.540394.BE

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Paul McManus, associate editor,
Ike Iheanacho, editor

¹ Drug and Therapeutics Bulletin, BMA House, London WC1H 9JR

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.