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Dr. Thomas P. Habif, MD discusses Acne Treatment with Oral Antibiotics Doxycycline. See more at www.dermnet.com PLEASE RATE AND COMMENT!!! Mechanism of action P. acne initiates inflammatory acne. The bacteria is usually present in small numbers. P. acne proliferates in the lipid rich environment of the microcomedo and produces proinflammatory mediators that cause papules, pustules and cysts. P. acnes is highly sensitive to many antibiotics. The problem is to deliver the drug into the lipid rich environment of the microcomedo.. Topical vs. Systemic antibiotics Moderate inflammatory acne with papules and pustules covering a wide area is treated with oral antibiotics and topical therapy. Patients treated with an oral antibiotic may be given topical antibiotics when the dose of the oral antibiotic is tapered. The response to oral antibiotics is unpredictable. Some patients respond while other do not. It is difficult to predict who will benifit. Patients with nodular cystic acne may improve with oral antibiotic therapy, but that response is often limited. These patients frequently fail a course of oral antibiotics and topical therapy and require isotretinoin. Treatment strategy Patients are treated with either a prolonged course or intermittent courses of antibiotics before a complete response is achieved. Oral antibiotics are usually given for a minimum of 1 to 3 months before the dose is reduced. Once the appearance of new inflammatory lesions has decreased or stopped, the …