Background: Commonly prescribed therapies in adolescent Acne vulgaris are topicalregimens and oral therapy, with first line antibiotic tetracycline. With the evidentincreasing resistance of Propionibacterium acnes to oral tetracycline, treatmentfailures are a consequence.Aim: The aim of this systematic review was to evaluate the currently published datainvestigating the efficacy and side effects of treatment with oral tetracycline versusother commonly prescribed acne therapies. The secondary aim was to evaluate thetreatment outcome related to propionibacterium acnes resistance to tetracycline.Methods: An electronic hand search was done in PubMed, Scopus and CochraneLibrary databases. Selected studies were limited to those in the English language witha 10-year span ranging from 2002-2012. Search terms conducted for all 3 databaseswere “Acne vulgaris” and “Tetracycline”. Only Randomized controlled trials (RCT)were included to provide the highest evidence. For each study the risk of bias wereassessed and a summary evaluation of the level of evidence (GRADE) wereconducted.Findings: The search provided a total of 95 studies in which they were analysedmeeting the predetermined eligibility criteria. In the final qualitative analysis 3 RCTstudies were included. There were no significant differences in efficacy comparingtopical regimens with antimicrobials versus oral tetracycline. Oral isotretinoin provedto have a superior efficacy compared to oral tetracycline. Adverse effects werepredictable for each therapy and oral isotretinoin gave the most severe events.Interpretation: Oral tetracycline is an effective therapy in moderate to severeinflammatory acne. Even in the presence of resistant Propionibacterium acnes it is asuccessful treatment, most possibly relating to its anti-inflammatory fashion. Topicaltherapy with antimicrobials have similar efficacy as oral tetracycline. Although oralisotretinoin provides the best efficacy compared to oral tetracycline it is well knownthat it gives more adverse effects.
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