A REAL-WORLD retrospective study from Shanghai has found that longer courses of oral antibiotics for moderate-to-severe acne may do more harm than good, increasing both recurrence rates and antimicrobial resistance without improving short-term outcomes.
Study Design: Real-World Analysis of Antibiotic Duration
Researchers analysed data from 240 patients aged 12-40 years who were treated with either doxycycline or minocycline between 2020 and 2023. Patients were divided into three groups based on treatment duration: short-term (6-12 weeks), standard-term (13-16 weeks), and prolonged therapy (17-24 weeks), with 80 patients in each group.
The primary endpoint was acne recurrence within 12 months. Results showed a clear duration-dependent increase in recurrence: 23.8% in the short-term group, 35.0% in the standard-term group, and 46.3% among those receiving prolonged treatment. Median recurrence-free survival also declined with longer antibiotic use, dropping from 9.2 months in the short-term group to 6.9 months in the prolonged group. Statistical analysis confirmed prolonged antibiotic exposure as an independent predictor of recurrence (adjusted hazard ratio 2.31; p = 0.004).
No Improvement in Short-Term Acne Outcomes
Despite these differences in long-term outcomes, short-term efficacy was similar across all groups. Around three-quarters of patients in each cohort achieved treatment success at 12 weeks, with no significant differences observed. Rates of scarring and adverse events were also comparable, suggesting no added clinical benefit from extended therapy.
Prolonged Use Tied to Increased Antibiotic Resistance
However, antimicrobial resistance told a different story. In a subset of 46 patients who underwent microbial culture testing, tetracycline resistance was significantly higher in the prolonged treatment group (42.9%) compared with the short- and standard-term groups (13.3-17.6%).
The findings reinforce concerns about the overuse of systemic antibiotics in acne management. While longer treatment durations might be assumed to provide sustained disease control, this study suggests the opposite, highlighting a higher likelihood of relapse and increased resistance risk.
The authors conclude that extended antibiotic use should be avoided where possible, supporting current guideline recommendations to limit treatment duration and prioritise antimicrobial stewardship strategies in acne care.
Reference
Wang L et al. Long-term impact of antibiotic exposure duration on recurrence and microbial resistance in moderate-to-severe acne: a real-world retrospective analysis. Front Med. 2026;13:1782651.
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