What is your opinion on antibiotic use for acne?

Nurses General Nursing

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I am currently working and a med-spa (though I have put my notice in and am going back to hospital nursing in a week).

The Dr. at this facility frequently prescribes antibiotics for long term use for people with acne problems. I am not sure I really agree with this considering all of the superbugs out there that we are creating due to overuse of antibiotics. Just wondering what everyone else thought of this?

Specializes in Med/Surg, Geriatrics.
topical treatments first, second, third , fourth, eightteenth ... only once all appropriate topical preparations have been proven not to work should the prescriber be considering Antibiotics or Roaccutane and by that time hopefully the patient will have been seen by a dermatologist or a Family Doc with a proven and documented Derm specialist interest.

Why should someone suffer through eighteen rounds of topical treatment if an antibiotic will clear it up in one?

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Specializes in Spinal Cord injuries, Emergency+EMS.
Why should someone suffer through eighteen rounds of topical treatment if an antibiotic will clear it up in one?

I doubt very much that there are 18 clinically indicated possible topical treatments ... however the answer you give is very much typical of that i have begun to associate with allnurses and it's USA -centric viewpoint , that the solution to all medical problems is the most expensive invasive and 'sexiest' treatment or investigation rather than a sensible and pragmatic approach that seeks to balance the following

- risks to the patient from the procedure or investigation - e.g. why CT when Ultrasound or observation is just as effective - oh yes it's 'customer service' and the radiologist can bill for it , plus the ridiculous 'standards of care' that a based on what they can get away with billing for rather than actual clinical evidence

- 'customer service' in prescribing such as those who advocate jumping straight for antibiotics to treat things , plus of course the continued indescriminate use of antibiotics in certain aspects of US clinical practice , the irony of course here being that the USA is far more over-dramatically concerned about MRSA than other places.

- a complete absence of cost control measures because someone else is paying for it - despite the fact many Americans are paying for services they cannot access visa tax contributions that pay for medicaid/ medicare and Military healthcare benefits as well as being couged for their own insurance , of course not helped by the outright lies being posted About the costs, 'over long waits' and 'death panels' of properly constructed single payer systems ...

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Specializes in Psych, Med/Surg, LTC.

Acne is so much more than just a cosmetic problem! It should be treated in different ways for different people. I suffered through acne in my pre-teen and teenage years and the psychological effects were awful. I started abx treatment in my 20's, and am so glad I did. I felt so much better about myself, and was even able to give up my eating disorder! If creams work, yay! use them. If not, I see nothing wrong with someone wanting to take oral abx. It is so much more than a cosmetic issue. You can't just hide your face/neck like you can hide varicose or spider veins by not wearing shorts/skirts/dresses/bathing suits. You have to show your face. Over the last few years, I discovered more natural methods of dealing with acne. I wish they were more known!

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Specializes in Pediatrics.
I doubt very much that there are 18 clinically indicated possible topical treatments ... however the answer you give is very much typical of that i have begun to associate with allnurses and it's USA -centric viewpoint , that the solution to all medical problems is the most expensive invasive and 'sexiest' treatment or investigation rather than a sensible and pragmatic approach that seeks to balance the following

Antibiotics are not usually expensive, not "sexy" in any sense of the word, and not invasive either. There's nothing wrong with treating acne with antibiotics- in many cases, it's a bacterial infection; why not use antibiotics, if they've been proven to work in similar cases? That IS a clinically indicated treatment, not an example of overuse or indiscriminate use of antibiotics.

As for the rest of your post, it doesn't seem to have much to do with this topic; if you feel passionately about it as you seem to, why not start a new thread in that direction? It seems like a topic that would prompt some interesting discussion on its own.

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Let me start off by saying, having struggled with cystic acne for 7 years (ages 13-21), I really have no problems with antibiotics perscriptions. People may see it as a comestic issue, but for people who suffer with moderate to severe cystic acne (which is what the antibiotics should be prescribed for), it isn't. The nodules hurt like heck sometimes. Believe me, too, to have that on your face in middle school and high school, it leaves scars way beyond the ones on your skin. I decided it treat it more aggressively my first year of nursing school. What patient would really want a nurse that looks unhealthy? Plus, the cysts bleed sometimes, and you can't have blood on your face at work.

The fact that antibiotics are affordable and fairly well tolerated probably makes them the popular treatment (my family would never have been able to afford laser treatments). However, I believe that patients need to be more educated about them. They need to know that antibiotics don't treat the root causes but only help mask the symptoms. They also need to know they lose their effectiveness over time. Moreover, practictioners need to approach it more holistically. If stress and hormones make the acne worse, they need to address that. Providers should be aware of how long patients have been using them (once I had changed providers and my new provider was so shocked to learn I had been taking the same one for five years-- that's unacceptable). Long term use needs to be managed carefully.

In short, antibiotics definitely have their place in treatment, but providers and patients need to be more aware of risks and consequences of long term use.

My thoughts from someone who's been there...

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I haven't read the whole thread yet, but as someone who suffers from acne I can tell you that it can be so seriously depressing and disfiguring that I would have taken anything my doctor gave me in hopes that it would work. For me, that was a combination of oral and topical antibiotics plus a medicated cream. Acne can cause serious mental distress for patients. As far as I am concerned antibiotics for acne is just as okay as antibiotics for sepsis.

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topical treatments first, second, third , fourth, eightteenth ... only once all appropriate topical preparations have been proven not to work should the prescriber be considering Antibiotics or Roaccutane and by that time hopefully the patient will have been seen by a dermatologist or a Family Doc with a proven and documented Derm specialist interest.

Patients should not need to be miserable for that long. You have obviously never had acne or you would know how disheartening it is for a patient to try round after round of useless medication. Antibiotics work for many people suffering with acne. IMHO Accutane is the absolute last resort, as it can cause serious, permanent joint and liver problems.

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Specializes in acute care med/surg, LTC, orthopedics.
Patients should not need to be miserable for that long. You have obviously never had acne or you would know how disheartening it is for a patient to try round after round of useless medication. Antibiotics work for many people suffering with acne. IMHO Accutane is the absolute last resort, as it can cause serious, permanent joint and liver problems.

Accutane, in my opinion, shouldn't be prescribed to women of child bearing years as it can cause horrible disfiguring birth defects, unless of course the woman is celibate. There are other less riskier options for acne treatment.

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Accutane, in my opinion, shouldn't be prescribed to women of child bearing years as it can cause horrible disfiguring birth defects, unless of course the woman is celibate. There are other less riskier options for acne treatment.

I agree. Only for a very severe case as an absolute last resort in my book. My derm suggested Accutane to me several times but I really wanted to try other things before going down that road. It is a good thing, too - I am pregnant now and even if I was off Accutane when I got pregnant I would still be very, very nervous about ever having been on it. My skin looks great now that I am pregnant but if my acne comes back in a few years when I am done having babies I might (and that is a big 'might') be willing to try it.

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Specializes in Acute Care, CM, School Nursing.

I remember being on topical stuff, as well as oral abx for my acne. I was fortunate, in that I never have very severe acne, covering my face/back. I did get the very large, deep, painful pimples though, fairly frequently. Believe me, having even one of those is enough to make you scream! The topical meds never worked for me. But, the oral abx did. I can't remember how long I took the abx for. But I do remember that once I stopped taking it, the acne came back.

I eventually did go on Accutane. I know it has a terrible reputation, but it really helped me. I was extremely careful with it, and produced the mandatory negative pregnancy test for my derm. If I remember correctly I didn't have a boyfriend at the time, so birth control wasn't an issue for me. I knew about the dangers to a fetus with the medication. I remember that my mucus membrances were soooo dry! I wasn't able to wear my contact lenses for a long time, either, due to my dry eyes. But, my skin really cleared up. I guess it's been maybe 15 years since I took it?? I have since had 2 gorgeous babies. ;)

Anyway, my question is, how long will a derm let you continue to take a certain antibiotic? I mean, is there a time frame, where you'll have to switch to a different type?

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I know a girl who has been taking antibiotics for 5 years for acne. I think it's insane. I've never seen acne on her worse than mine as a teenager and I considered mine pretty mild. I had a pretty rough time finding products taht would clear up my face but I eventually found a mask tha contains Glycolic Acid & Salicylic Acid (i think i ahve those names right) that I use a couple times a week and it does a really good job (when I actually use it often enough lol). I can see prescribing them for a particularly bad breakout or to get it undercontrol but long-term use scares me.

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I took oral antibiotics for acne for over a year and am absolutely convinced it ruined my immune system. I allow my daughter a topical antibiotic for her acne regimen but refuse systemic. There are far worse things than acne in this world.

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