Acne Antibiotics Compared: Lymecycline, Doxycycline and More
How the antibiotic tablets used for acne differ, why they're always taken with a cream or gel, how long a course lasts, and what to expect.
Part of our acne health guides.
Key fact: Antibiotic tablets are used for moderate to severe acne, always together with a retinoid or benzoyl peroxide cream or gel, for up to 6 months. NICE recommends lymecycline or doxycycline first; oxytetracycline and minocycline are alternatives when those don't suit you.
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Most acne starts with a cream or gel. NICE recommends adding an antibiotic tablet for moderate to severe acne, for example lots of inflamed spots, acne on the back and chest that is hard to reach, or acne that hasn't improved enough with a cream or gel alone. All four tablets below are tetracyclines, a family of antibiotics that reduce acne bacteria and calm inflammation.
Lymecycline, doxycycline and oxytetracycline are all tetracycline antibiotics, which is the answer to "what type of antibiotic is doxycycline?" or "is lymecycline an antibiotic?"
The four tablets compared
| Lymecycline | Doxycycline | Oxytetracycline | Minocycline | |
|---|---|---|---|---|
| NICE position | First choice | First choice | Alternative | Not a first choice; only if others don't suit |
| Dose for acne | One 408mg capsule a day | One 100mg capsule a day | Two 250mg tablets twice a day | One 100mg modified-release capsule a day |
| Food | With or without food | With food can reduce sickness | Empty stomach: 1 hour before or 2 hours after food | With or without food |
| Sun sensitivity | Possible | More likely: sunscreen essential | Possible | Possible |
| Main extra cautions | Few | Swallow upright with water; don't take just before bed | Milk and food stop it working | Skin pigmentation, rare lupus-like and liver reactions, dizziness |
| Brand names | Tetralysal 300 | Minocin MR |
Oxytetracycline, Tetralysal and Minocin MR are currently out of stock at our pharmacy. Lymecycline and doxycycline are available.
Lymecycline or doxycycline?
Both are NICE first choices, taken once a day, and they work equally well for most people. The differences are practical:
- Lymecycline can be taken with or without food, and a moderate amount of milk doesn't affect it.
- Doxycycline is more likely to make skin burn in the sun, so it may suit you less in summer or if you work outdoors. It must be swallowed with a full glass of water while sitting or standing, and not taken just before bed, to avoid irritating the food pipe.
- If one causes side effects, the other is a reasonable switch.
The rules every course follows
1
Always with a cream or gel
A retinoid or benzoyl peroxide (for example Epiduo, Differin or Acnecide), from day one. This stops bacteria becoming resistant and treats blocked pores, which antibiotics don't.
2
Never with an antibiotic cream or gel
Not with Duac, Treclin, Zindaclin or Dalacin T. Two antibiotics together increase resistance.
3
Review at 12 weeks
That's when it can fairly be judged. If it hasn't helped, continuing rarely does.
4
No more than 6 months
NICE says courses shouldn't go beyond 6 months except in exceptional circumstances. We supply 3 months at a time, up to 6 months in total.
Taking them properly
- Swallow capsules whole with a full glass of water, sitting or standing.
- Leave 2 hours between your antibiotic and indigestion remedies, or iron, zinc or calcium supplements.
- Use a high-factor sunscreen and avoid sunbeds.
- Keep taking it every day, even when your skin looks better.
- Tetracyclines don't stop the contraceptive pill working, according to the Faculty of Sexual and Reproductive Healthcare. If you're sick or have severe diarrhoea, follow your pill's missed-pill advice.
Side effects to know about
Most people take them without problems. The most common side effects are feeling sick, stomach ache, diarrhoea and headache, and some women get thrush.
Stop and get medical advice if you get a severe headache with blurred or double vision (raised pressure in the head), yellow skin or eyes, a severe rash with blistering, or, with minocycline, blue-grey patches on the skin, gums or nails or joint pain with a rash. Call 999 if your face, lips or throat swell or you have difficulty breathing.
None of these tablets can be taken in pregnancy or while breastfeeding, because tetracyclines affect a baby's developing teeth and bones. If you need an antibiotic and can't take a tetracycline, your GP can consider an alternative such as erythromycin.
What happens after a course
When the antibiotic stops, you keep using your cream or gel to stay clear. Stopping everything usually means acne returns within months; see acne maintenance and relapse. If acne comes back quickly after two good courses of treatment, or is scarring, ask your GP about a dermatology referral and isotretinoin.
To compare the creams and gels that go with these tablets, see acne creams and gels compared.
Frequently asked questions
Is lymecycline or doxycycline better for acne?
They work equally well for most people, and NICE recommends either as the first-choice antibiotic for moderate to severe acne. Lymecycline can be taken with or without food. Doxycycline is more likely to make your skin burn in the sun and must be swallowed upright with plenty of water. Both are taken once a day, always with a cream or gel.
What type of antibiotic is doxycycline?
Doxycycline is a tetracycline antibiotic, the same family as lymecycline, oxytetracycline and minocycline. For acne, it reduces the bacteria linked to spots and calms inflammation. The usual acne dose is 100mg once a day.
Is lymecycline an antibiotic?
Yes. Lymecycline is a tetracycline antibiotic, sold as a generic and as the brand Tetralysal 300. For acne, it is taken as one 408mg capsule a day, always alongside a retinoid or benzoyl peroxide cream or gel.
How long can you take antibiotics for acne?
A course is reviewed at 12 weeks and, according to NICE, shouldn't usually go beyond 6 months. Taking antibiotics for longer adds little benefit and makes resistance more likely. After the course, you keep using your cream or gel to keep acne away.
Why do I need a cream with acne antibiotics?
Because an antibiotic on its own lets acne bacteria become resistant, and it doesn't unblock pores. A retinoid or benzoyl peroxide cream or gel prevents resistance, treats blackheads and whiteheads, and keeps acne away after the antibiotic stops.
Do acne antibiotics stop the pill working?
No. Tetracycline antibiotics such as lymecycline and doxycycline don't make the combined pill or other hormonal contraception less effective, according to the Faculty of Sexual and Reproductive Healthcare. If you're sick or have severe diarrhoea, follow the missed-pill advice in your pill's leaflet.
Why is minocycline not usually prescribed first?
Minocycline works in a similar way to the other tetracyclines, but it has rarer and more serious side effects, including blue-grey skin pigmentation and lupus-like or liver reactions. NICE recommends lymecycline or doxycycline first, and minocycline is only used when they aren't suitable.
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Complete a short online consultation about your skin and any treatments you have tried. A GPhC-registered pharmacist prescriber recommends a treatment and, if it is suitable, we dispatch it from our UK pharmacy. For adults 18 and over.
Start Acne Consultation →References
- National Institute for Health and Care Excellence. Acne vulgaris: management (NG198). nice.org.uk/guidance/ng198
- NICE Clinical Knowledge Summaries. Acne vulgaris. cks.nice.org.uk/topics/acne-vulgaris
- Summaries of product characteristics for each medicine named, electronic medicines compendium. medicines.org.uk/emc
- Faculty of Sexual and Reproductive Healthcare. Drug interactions with hormonal contraception. fsrh.org
- NHS. Doxycycline. nhs.uk/medicines/doxycycline
Medical disclaimer: This page is for information only and isn't a substitute for medical advice. Most of the treatments mentioned are prescription-only, so a clinical consultation is needed before they can be supplied. Many acne treatments must not be used in pregnancy. Always follow your prescriber's advice and the leaflet. In a medical emergency, call 999.