Which medications in the drug class Antibiotics are used in the treatment of Rosacea?

Updated: Jun 03, 2021
  • Author: Agnieszka Kupiec Banasikowska, MD; Chief Editor: William D James, MD  more...
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Since the 1950s, oral antibiotics have been prescribed off label for treatment because microorganisms were thought to be the underlying cause of disease. In current practice, experts do not believe bacterial infection plays a part in the pathogenesis of rosacea; however, the antibiotics, particularly the tetracyclines, continue to be used for their anti-inflammatory properties. Since 2006, nonantibiotic dosing of doxycycline has become first-line treatment for many clinicians. In many cases, oral and topical antibiotics are used in combination; the oral treatment may be eventually withdrawn and the topical treatment is used alone as maintenance therapy. However, in patients with ocular involvement, oral therapy needs to be maintained.

In patients who require a systemic antibiotic, evidence suggests that the newer regimen of 20-50 mg q12h of doxycycline is as effective as the older regimen of 100 mg of doxycycline. For many patients, this could represent a significant cost reduction.

Metronidazole gel 0.75% or 1% (MetroGel, Noritate, MetroLotion)

Metronidazole is an imidazole ring–based antibiotic active against various anaerobic bacteria and protozoa.

Oral metronidazole has been shown to be beneficial against papules and pustules of acne rosacea.

Topical applications are helpful for mild disease and as an adjuvant to systemic therapy.

Erythromycin (E.E.S., Erythrocin, Ery-Tab) tab or 2% topical solution

Erythromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is used for the treatment of staphylococcal and streptococcal infections.

In children, age, weight, and severity of infection determine the proper dosage. When twice-daily dosing is desired, half the total daily dose may be taken every 12 hours. For more severe infections, double the dose.

Erythromycin can be used when tetracyclines are not tolerated or are contraindicated.

It is used for the treatment of ocular rosacea.

Clindamycin topical (Cleocin T, Clindagel, Evoclin)

Clindamycin is a semisynthetic antibiotic produced by 7(S)-chloro substitution of 7(R)-hydroxyl group of its parent compound lincomycin. It inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Clindamycin widely distributes in the body without penetration of the CNS. It is protein bound and excreted by the liver and kidneys.

Upon application to skin, drug is converted to active component, which inhibits the microorganism.

Available as topical solution, lotion, or gel for external use. Solution contains equivalent of 10 mg/mL clindamycin.

Effective against mild-to-moderate papulopustular rosacea.


Tetracycline inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s). It has anti-inflammatory activity. Improvement is evident within 2-4 months after commencement of therapy.

Minocycline (Dynacin, Minocin, Solodyn)

Minocycline treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible P acnes. The extended-release tablet (Solodyn) has a variety of doses ranging from 45 mg up to 135 mg and can be administered once daily.

Minocycline topical (Zilxi)

The precise mechanism of action by which topical minocycline exerts its affects for acne is unknown, but it is thought to elicit anti-inflammatory effects. The 1.5% topical foam is indicated to treat inflammatory lesions of rosacea in adults.

Doxycycline (Oracea, Doryx, Periostat, Vibramycin)

Doxycycline is a broad-spectrum, synthetically derived, bacteriostatic antibiotic in the tetracycline class. It is almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.

Doxycycline inhibits protein synthesis and, thus, bacterial growth, by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. It may block dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Clarithromycin (Biaxin, Biaxin XL)

Clarithromycin is a semisynthetic macrolide antibiotic that reversibly binds to P site of 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis by stimulating dissociation of peptidyl tRNA from ribosomes, causing bacterial growth inhibition.

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