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Doxycycline and Minocycline
Official Names: Doxycycline and Minocycline
Common Brand Names for Doxycycline: Doxy, Periostat and Vibramycin.
Common Brand Names for Minocycline: Aknemin, Minocin, Myrac, and Solodyn.
Doxycycline and Minocylcine Background
Doxycycline and minocycline are the two most commonly prescribed oral antibiotics for the treatment of acne. Both doxycycline and minocycline are members of the tetracycline family of antibiotics and work by preventing bacteria from synthesizing new proteins.
Doxycycline and minocycline have been the oral antibiotic of choice for acne for many years. However, the increasing frequency of infections caused by bacteria resistant to tetracycline family antibiotics has caused some dermatologists to begin expoloring alternative antimicrobial therapies. The proportion of patients whose acne fails to respond to treatment with either doxycycline or minocycline is especially high in developed countries, like those of Europe and North America.
Despite the increasing frequency of resistant bacteria, the generally accepted prescribing guidelines in both Europe and North America still call for the use of tetracycline family antibiotics as the first line oral treatment for recalcitrant acne vulgaris. This is likely due to both the historical efficacy of tetracycline treatment, and the relatively low incidence of adverse reactions in patients taking these medications.
Doxycycline is also one of the primary treatments for many common diseases, including certain sexually transmitted diseases, such as gonorrhea and chlamydia.
Additional Names for Doxycycline: Adoxa, Antodox, Atridox, Bassado, Biomoxin, By-Mycin, Cadoxy, Ciclonal, Clinofug, Deoxymykoin, Doksiciklin, Doryx, Dosil, Dotur, Doxat, Doxibiotic, Doxiciclina, Doxicin, Doxicip, Doximal, Doximycin, Doxine, Doxitab, Doxitin, Doxoral, Doxsig, Doxycaps, Doxycin, Doxyclin, Doxycyclin, Doxycyclinum, Doxydar, Doxyderm, Doxydyn, Doxyferm, Doxyhexal, Doxylag, Doxylets, Doxylin, Medomycin, Microdox, Miraclin, Monodoks, Monodox, Oracea, Oraxyl, Otosal, Peledox, Proderma, Protectina, Relyomycin, Spanor, Tetradox, Unidox, Vibra, Vibra-Tabs, Vibracina, Vibradox, Vibramicina, Vibramycine, Vibranord, Vibravenös, Vibravenosa and Vibrox.
Additional Names for Minocycline: Acnamino, Acneclin, Akamin, Aknefug, Aknoral, Aknosan, Arestin, Cyclimycin, Cyclin, Cynomycin, Dynacin, Klinotab, Melicin, Mestacine, Micromycin, Minac, Minakne, Mino-Tabs, Minociclina, Minoclin, Minoclir, Minocyclin, Minocyclinum, Minoderm, Minolis, Minomax, Minomycin, Minopen, Minoplus, Minosil, Minostad, Minotab, Minotrex, Minox, Mynocine, Namimycin, Pardoclin, Parocline, Pracne, Sebact, Seboclear, Sebomin, Sebren, Skid, Skinocyclin, Udima, Vectrin and Zacnan.
Doxycycline and Minocycline in the Treatment of Acne
Doxycycline and minocycline are closely related antibiotics, and both are similarly effective in the treatment of acne. However, there are important differences between the two and there is considerable debate within the dermatology community about which particular antibiotic is better for treating acne. Some dermatologists prefer minocycline because it has a longer half-life than doxycline (stays in your system longer) and it is more lipid soluble. The better lipid solubility of minocycline could potentially allow more of it to accumulate in the sebaceous glands and sebum, putting it in direct contact with the target P. acnes bacteria.
However, minocycline also tends to have slightly higher rates of adverse effects than doxycycline. Minocycline also tends to be more expensive than doxycycline, which may influence the decision between the two antibiotics. There is also some evidence that tetracycline family antibiotics, and minocycline in particular, may also have anti-inflammatory properties that are helpful in improving acne symptoms. However, while there is some research that minocycline may help improve certain types of chronic inflammation (eg. rheumatoid arthritis) there is little evidence that this type of anti-inflammatory activity is directly helpful for improving acne symptoms.
The research data about the antibiotic susceptibility of Propionibacterium acnes bacteria indicates that resistance to all of the tetracycline family antibiotics (tetracycline, minocycline and doxycycline) is becoming relatively common. While most bacteria that are resistant to one of these antibiotics are also resistant to the others, the research suggests that some doxycycline-resistant P. acnes may be susceptible to minocycline (and vice versa). In cases where acne symptoms are caused by tetracycline-susceptible P. acnes bacteria, treatment with doxycycline or minocycline generally produces excellent results. However, because tetracycline-resistant P. acnes bacteria are quite common, many cases of acne vulgaris fail to respond well to either minocycline or doxycycline.
A common misconception is that oral antibiotic treatments (and especially doxycycline and minocycline) may take several months to significantly improve acne symptoms. This is belief is not true, and is based on a fundamental misunderstanding of what causes acne and the factors that influence the development of acne lesions. While it is true that symptoms should continue to improve as treatment continues, an effective oral antibiotic treatment should produce significant improvement within 1-2 weeks. An effective antibiotic regimen should inhibit the growth of inflammation-inducing bacteria almost immediately. Inflammation should begin to resolve as the existing bacteria and bacterial byproducts are processed and removed by the immune system. If there is no improvement (or only minor improvement) after a month, the most likely reasons are that either the infection is caused by bacteria that are resistant to that antibiotic, the dose of antibiotic is not high enough or that bacterial infection is not the primary cause of the acne symptoms. The idea that antibiotics take a long time to act, or that they need to build up in your system in order to work is flawed (unless you are talking about a tuberulosis infection, which involves latent infections of metabolically inactive bacteria, and requires a long course of antibiotic treatment).
For patients whose acne fails to respond effectively to treatment with tetracycline family antibiotics, either co-trimoxazole or amoxicillin may provide superior results. For example, a European study found that 79% of people who suffered from tetracycline-resistant acne experienced significant improvement in their acne symptoms after switching to co-trimoxazole (400 mg sulfamethoxazole/80 mg trimethoprim twice daily). If your acne fails to respond to doxycycline or minocycline treatment, don’t be shy about asking your physician or dermatologist to consider alternative treatments. It’s your body and your skin, and the squeaky wheel gets the grease.
Patient Reviews of Doxycycline and Minocycline
Doxycycline and Minocycline Reviews @ Acne.org – Acne.org has reviews and forums where patients can discuss their experiences with different acne medications. However, it is important to be aware that some of the information and statements posted on these forums are innacurate, or even completely wrong.
Doxycycline and Minocycline Reviews @ WebMD – WebMD also offers forums where patients can discuss and review their experiences. Again, some of the information submitted by users is not accurate.
Doxycycline and Minocycline Reviews @ Drugs.com – Another good resource for gathering information about other people’s experiences with this medication.
Cost and Availability of Doxycycline and Minocycline
If possible, doxycline and minocycline should be obtained through consultation of a qualified medical professional. Most physicians and dermatologists familiar with these medications and are comfortable with their use for the treatment of acne vulgaris. Both antibiotics are widely available in brand name and generic formulations. Brand name formulations tend to be moderately expensive to very expensive, and generic formulations tend to be inexpensive to moderately expensive.
Side Effects of Doxycycline and Minocycline
The most common side effects from tetracycline family antibiotics are upset stomach and other gastro-intestinal problems.
In some people, tetracycline family antibiotics cause photosensitivity reactions that increases the risk of sunburn. Allergic reactions, nausea and headaches are also potential side effects of this type of drug.
Tetracyclines can cause growing teeth to become yellowed and discolored, and the use of these antibiotics is limited in children and pregnant women. Tetracycline family antibiotics that are expired or have been stored improperly may degrade into toxic byproducts. Therefore it is essential to properly store tetracyclines and to pay especially close attention to expiration dates.
The absorption of tetracycline antibiotics is inhibited by the presence of certain minerals, like calcium and magnesium, and it is important to take them with a full glass of water and avoid consuming mineral supplements or calcium rich foods (dairy) within several hours of taking the medications.
Minocycline, but not other tetracycline family antibiotics, may cause inner ear disturbances with associated dizziness, ataxia, vertigo and tinnitus. This type of side effect is much more common in women than in men. As a result, minocycline is rarely prescribed to women.
For more in-depth information about potential side effects of doxycline or minocycline treatment, refer to the physician’s insert for tetracycline family antibiotics, or consult a medical professional. For more information about contraindications in general, refer to Avoiding Negative Drug Interactions.
References and Sources
PDR Staff Writers. 2011. 2011 Physicians’ Desk Reference (PDR)
Gallagher. 2011. Antibiotics Simplified, Second Edition
Habif. 2009. Clinical Dermatology
Goodheart. 2006. Acne For Dummies
Bartlett. 2012. Johns Hopkins ABX Guide 2012 (Johns Hopkins Medicine)
Doxycycline and Minocycline @ PubMed Health – The National Institute of Health (US) offers basic comprehensive information about most common medications.
Doxycycline and Minocycline @ Wikipedia – Wikipedia is an excellent resource for learning about how medications work.
Tetracycline Family Antibiotics Physician’s Insert – The physician’s insert for a medication contains nearly all of the relevant information, including indications, dosage information and background data.
Goulden, et al. 2008. Safety of long-term high-dose minocycline in the treatment of acne.
Oprica, et al. 2004. Antibiotic-resistant Propionibacterium acnes on the skin of patients with moderate to severe acne in Stockholm.
Nordin, et al. 1978. A clinical and bacteriological evaluation of the effect of sulphamethoxazole-trimethoprim in acne vulgaris, resistant to prior therapy with tetracyclines.
Garner, et al. 2003. Minocycline for acne vulgaris: efficacy and safety.
Eady, et al. 2006. Tetracycline-resistant propionibacteria from acne patients are cross-resistant to doxycycline, but sensitive to minocycline.
Hubbell, et al. 1982. Efficacy of minocycline compared with tetracycline in treatment of acne vulgaris.
Eady, et al. 2006. Superior antibacterial action and reduced incidence of bacterial resistance in minocycline compared to tetracycline-treated acne patients.
Piérard-Franchimont, et al. 2002. Lymecycline and Minocycline in Inflammatory Acne: A Randomized, Double-Blind Intent-to-Treat Study on Clinical and in vivo Antibacterial Efficacy.
Kaufmann, et al. 1994. Severe episode of high fever with rash, lymphadenopathy, neutropenia, and eosinophilia after minocycline therapy for acne.
Harrison, et al. 2006. A comparison of doxycycline and minocycline in the treatment of acne vulgaris.