The problem of systemic antibiotics is increasing resistance of p. acnes. Oxytetracycline Start at 500 mg BD, one hour before meals, or four hours after meals. Continue for at least six months on this dose. Avoid in children and avoid in pregnancy. BD Tetracyclines are usually well tolerated although the bowels may be upset with either diarrhoea or constipation early on in treatment.
Vaginal candidiasis is fairly common.
A rare side effect with Tetracyclines is benign intracranial hypertension and so beware headaches and examine the optic fundi. The evidence for one Tetracycline over another is not strong but the daily treatments are certainly easier for the patients. We consider that minocin MR may well be the most effective, but it is very expensive, and does have some rare side effects. We would not usually start with it. It can be taken with food.