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In recent years oral antibiotics are now given by dermatologists as a first line treatment for rosacea along with topical metronidazole.  Oracea has become the most recent popular antibiotic because it is low dose and touted as an anti-inflammatory rather than antibiotic, but nevertheless, is still an antibiotic. Generally speaking, taking these antibiotics for rosacea is long term since after short term use rosacea comes right back. Why is long term use of antibiotics the treatment?  According to Dr. James Del Rosso, professor of dermatology at the University of Nevada, says, ”We know that it’s best, in an ideal world, that patients are not on long-term antibiotic therapy. The reality is that patients are there for treatment, and part of the effective treatment that we have to date is giving them antibiotics. And so we’re caught in the middle until we have some better, definitive ways to solve the problem.” [1]  So what doctors are trying to do is reduce the dosage to a minimal amount that still treats the rosacea effectively, hence low dose tetracycline, Oracea. We have no idea what the long term effects of taking Oracea are since the safety of using Oracea hasn’t been established beyond nine months. All we do know is the long term effects of antibiotics since they have been used for a long time. What are the long term risks and side effects of antibiotic use?

Long Term Risks

There are many risks associated with long term antibiotic treatment and probably the foremost concern is antibiotic resistance which is is a type of drug resistance where a microorganism is able to survive exposure to an antibiotic. This problem is aggravated when “the greater the duration of exposure the greater the risk of the development of resistance irrespective of the severity of the need for antibiotics.” [2] There are, of course, other risks associated with long term antibiotic resistance including bacterial overgrowth, digestive problems usually due to changes in gut microflora, lower levels of phytoestrogens and compromising the immune system. [3] This doesn’t even take into account the many side effects of antibiotic treatment which are too many to list here. [4]

So a rosacean should ask his doctor what are the long term risks associated with taking an antibiotic, including Oracea, including the side effects and determine if the risks are worth the benefits.  This what is called the risk-benefit analysis. If you decide to accept long term antibiotic treatment, including Oracea, you will discover later what these risks are for yourself but at least you were warned.

For more information on this subject CLICK HERE.

Sources

[1] NPR
Doubts Raised Over Antibiotic Use for Acne by Allison Aubrey

[2] Wikipedia

[3] The Long-Term Effects of Antibiotics on Health and Immunity

[4] Antibiotics
The Merck Manuals

Oracea is now being promoted by Galderma as a first line treatment of rosacea along with its metronidazole brand name topical treatments for rosacea. Galderma bought Collegenex who originated the brand name Oracea prescription only oral treatment for rosacea that is FDA approved. Oracea is enteric coated with 10 mg of ‘delayed released beads’ and 30 mg of immediate release doxycycline and is advertised as anti-inflammatory and ‘submicrobial’ rather than antibiotic. This is supposed to reduce the chances of developing antibiotic resistance in long term use. The majority of rosacea users report success in using Oracea but some negative reports have been found.

According to a University of California Davis School of Medicine, report, “Recently, subantimicrobial-dose doxycycline was demonstrated to be an effective treatment for rosacea, due to its inherent anti-inflammatory properties. Furthermore, subantimicrobial-dose doxycycline has a more preferable tolerability profile and a lower occurrence of bacterial resistance than traditional-dose doxycycline. To further elucidate the role of tetracycline agents in rosacea, clinical trials that compare these agents with each other as well as with other effective rosacea treatments are called for.”

It will be good to see if clinical studies will be done on the effectiveness of Oracea compared with low dose doxycycline or tetracycline. For more information and a collection of reports of users of Oracea click here.