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Oral antibiotics

Oral antibiotics for Rosacea can be effective as they are anti-inflammatory. A short course is recommended only.

Oral antibiotics

Oral Antibiotics

Oral antibioitcs are use for Papulopustular Rosacea only but this is to treat inflammation rather than any bacteria that are present.

This should be a last resort treatment to prevent the build up of bacterial resistance.

The optimal duration of antibiotic therapy is not known.

A lack of response after 2–3 months of antibiotic therapy is usually regarded as treatment failure and should ideally be discontinued after 6 weeks.

Antibiotics have no effect on flushing.

On label:

Oxytetracycline 500mg bd

Tetracycline 500 mg bd

Doxycycline modified release 40 mg od (Efracea).

Off label

Doxycycline 100 mg od – take with food (not just water) as sticky.

Lymecycline 408 mg od

Trimethoprim 200mg bd (good second line)

Erythromycin 500mg bd

Doxycycline modified-release 40 mg od (Efracea)

Low dose.

Never reaches antibiotic dose levels, so fewer GI side effects.

Once daily.

Fewer side-effects and equivalent efficacy as full dose (100 mg).

Sub-microbial dose reduces the risk of antibiotic resistance compared with other antibiotics.


A reduced dose of oral antibiotic for 2–6 months followed by a 'drug holiday'.


Use a topical treatment on alternate days or twice a week.

Can combine oral with topical treatments with resistant cases.

Mechanism of action

Anti-inflammatory action, inhibitory effects on angiogenesis, leukocytic chemotaxis, inflammatory cytokines, and matrix metalloproteinases.

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