A Systematic Review of the Effects and Side Effects of Treatment with Oral Tetracycline in Acne Vulgaris

Abstract

Background: Commonly prescribed therapies in adolescent Acne vulgaris are topical regimens and oral therapy, with first line antibiotic tetracycline. With the evident increasing resistance of Propionibacterium acnes to oral tetracycline, treatment failures are a consequence. Aim: The aim of this systematic review was to evaluate the currently published data investigating the efficacy and side effects of treatment with oral tetracycline versus other commonly prescribed acne therapies. The secondary aim was to evaluate the treatment outcome related to propionibacterium acnes resistance to tetracycline. Methods: An electronic hand search was done in PubMed, Scopus and Cochrane Library databases. Selected studies were limited to those in the English language with a 10-year span ranging from 2002-2012. Search terms conducted for all 3 databases were “Acne vulgaris” and “Tetracycline”. Only Randomized controlled trials (RCT) were included to provide the highest evidence. For each study the risk of bias were assessed and a summary evaluation of the level of evidence (GRADE) were conducted. Findings: The search provided a total of 95 studies in which they were analysed meeting the predetermined eligibility criteria. In the final qualitative analysis 3 RCT studies were included. There were no significant differences in efficacy comparing topical regimens with antimicrobials versus oral tetracycline. Oral isotretinoin proved to have a superior efficacy compared to oral tetracycline. Adverse effects were predictable for each therapy and oral isotretinoin gave the most severe events. Interpretation: Oral tetracycline is an effective therapy in moderate to severe inflammatory acne. Even in the presence of resistant Propionibacterium acnes it is a successful treatment, most possibly relating to its anti-inflammatory fashion. Topical therapy with antimicrobials have similar efficacy as oral tetracycline. Although oral isotretinoin provides the best efficacy compared to oral tetracycline it is well known that it gives more adverse effects.