Antibiotics for rosacea

Antibiotics may reduce overall inflammation of your skin. Antibiotics also reduce the number of pimples (papules and pustules) and the amount of redness around pimples.

You can apply antibiotics directly to the skin (topically), or you can take them by mouth (orally). Topical antibiotics kill bacteria that are on the skin. Oral antibiotics kill bacteria in the skin pores and work best if they are started at high doses. When symptoms improve, you can taper off the oral antibiotics and then use a topical antibiotic instead.

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.

Typically, treatment begins with an oral antibiotic, such as tetracycline hydrochloride, minocycline, or doxycycline, which will be tapered off after symptoms improve. Long-term use of oral antibiotics may cause side effects. Following treatment with oral antibiotics, the person will then use 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.¹

Sulfacetamide and sulfur lotion are helpful with inflammatory rosacea. They are available in different tints and tend to hide redness. Your doctor can prescribe these for you.

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 lactobacillus/active cultures may help prevent some of these side effects.

A recent large study indicates that people who take erythromycin along with certain common medications may increase their risk of sudden cardiac death.² The study showed that the risk of sudden cardiac death is greater when erythromycin is taken with some medications that inhibit certain liver enzymes—such as certain calcium channel blockers, certain antifungal medications, and some antidepressants—than when these medications are not taken together.

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 and also may alter 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. Dahl MV, et al. (1998). Topical metronidazole maintains remissions of rosacea. Archives of Dermatology, 134(6): 679–683.

2. Ray WA, et al. (2004). Oral erythromycin and the risk of sudden death from cardiac causes. New England Journal of Medicine, 351(11): 1080–1096.

Author:	Nancy Bateman Lila Havens	Last Updated August 11, 2005
Medical Review:	Patrice Burgess, MD - Family Medicine Kathleen Romito, MD - Family Medicine Randall D. Burr, MD - Dermatology
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