Appendix 4 Embase Search Strategy
1. random$.mp.3. .mp.4. placebo$.mp. or PLACEBO/5. .mp. 6. .mp. 7. .mp.11. Randomized Controlled Trial/12. Single Blind Procedure/13. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 1214. exp acne vulgaris/18. 10118908.rn.19. “7 dimethylamino 6 demethyl 6 deoxytetracycline”.mp.20. .mp.21. .mp.22. 17 or 18 or 19 or 20 or 2123. 13 and 16 and 22
Minocycline And Bacterial Resistance
Another issue with minocycline use is bacterial resistance.
All antibiotics both those taken according to correct dosing schedules and those taken incorrectly are at risk of developing bacterial resistance.
Bacterial resistance occurs when bacteria adapts to the medicine and becomes immune to it. Eventually, this causes bacteria to grow despite of the medication, and the medication essentially stops working.
Bacterial resistance can happen at any time or not at all. For some, it happens right away, and immediately your acne will grow back. Often it takes longer than a few months, but long term minocycline use often leads to bacterial resistance, which in turn means your acne is no longer able to be kept at bay by the medicine.
Another issue, though rare, is resistance to more serious bacterial infections. It’s possible to catch more dangerous bacteria that becomes immune to minocycline, reducing one possible treatment option. This is one of the reasons that antibiotic use without an illness is generally discouraged in order to prevent more serious bacteria from becoming immune to antibiotic treatments.
How To Take And Store
Exact dosage and frequency will be determined by your healthcare provider but the FDA suggests:
- Comes in capsule or tablet form.
- May be taken with or without food.
- Take with a full glass of liquid to decrease gastrointestinal upset.
- Take exactly as directed even if feeling better. Finish the entire prescription.
- Take a missed dose as soon as you think about it.
- Take minocycline exactly as directed.
- Do not take two doses at the same time or extra doses.
Follow these guidelines for storage:
- Store in the airtight original container
- Protect from light, extreme heat, and extreme cold
- Keep away from moisture
- Keep away from children.
- Dispose of unused medication through a pharmacy or a medication disposal company.
- Once expired, dispose of medication.
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Frequently Asked Questions About Minocycline
Why can’t you lie down after taking minocycline ?
Minocycline can irritate the esophagus, which is the pipe that moves food and medications down into your stomach. If you lie down too soon after taking minocycline , the medication is more likely to go back up the esophagus and cause irritation. It’s best to stay sitting or standing upright for a while after taking each dose. Drinking lots of water with each dose also helps to prevent this problem.
Is minocycline a penicillin?
No. Minocycline is not related to penicillins. It is a tetracycline, which is a different class of antibiotic. If you have an allergy to penicillin, it’s possible that your provider prescribed minocycline as an alternative to penicillin-type antibiotics.
How long does it take minocycline to work?
When using minocycline to treat an infection, most people will start to feel better after 2 days. Some types of infection need more than just a few days of medication, so you might not feel effects quite as quickly. Be sure to finish all of your medication even if you feel like you don’t need it anymore. If you are taking minocycline for acne, it can take several weeks for this medication to start working.
How does minocycline work on the skin?
Does minocycline darken skin?
Minocycline Safety And Side Effects
Minocycline can cause adverse effects that range from mild to potentially serious. Common side effects include:
- Color changes or pigmentation of the teeth, nails, or skin
- Dizziness or a spinning sensation
- Increased pressure in the brain
- Increased susceptibility for sunburns
Additional safety considerations include:
- Children under eight years of age should avoid minocycline. Minocycline can cause weakening and discoloration of teeth and bone in young children or infants whose mothers used it during pregnancy
- People who are taking oral retinoids such as isotretinoin with minocycline may experience increased pressure inside the skull
- People with preexisting liver or kidney disorders may be at increased risk for liver and kidney problems with minocycline
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Minocycline For Treating Acne
Using Minocycline for acne is one the most effective and safe option. The drug works in two ways.
- Firstly, it halts the growth of bacteria that is responsible for the acne breakouts.
- Secondly, Minocycline can also help with other symptoms related to acne such as reduction of inflammation and redness.
- Minocycline is often prescribed when for moderate or severe acne. It is rarely recommended for mild acne.
- On the other hand, the drug Minocycline has no effect on blackheads and other non-inflamed acne outbreaks.
- The dosage needed to treat pimples can vary from person to person depending on the severity of acne.
- The recommended dose may be between 50-100 mg taken once or twice a day. Although it advised to take minocycline on an empty stomach, it can be consumed after a meal.
- Once the acne is under control, the dermatologist will slowly decrease your dose. Sometimes oral anti-biotics must be taken for long period of time to stop them from relapsing.
How Do I Take Oral Antibiotics
Doxycycline works best when you take it on an empty stomach, but it also has a tendency to make you want to puke. Try your best to take it on an empty stomach and soldier. If you cannot handle the urge to throw up, then take it after a meal. Whatever you do, do not take doxycycline with calcium or antacids. Both will bind to it and shoot directly through your body without getting used! If you decide to take it after a meal, then it must be low in dairy products. Milk in coffee, tea, or moderately in cereal is fine. Do not take doxycycline before bed. The pill can upset your throat and cause heartburn or perhaps an ulcer. Take it at least 30 minutes before a nap of sleep and follow it up with a big glass of water.
No rules. Simply take it.
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Potential Biases In The Review Process
The limitations of this review stemmed from the methodological insufficiencies and the subsequent heterogeneity in the primary studies, and the inadequacies of the reported data. The studies generally included insufficient numbers of participants, and the majority were only of 12 weeks duration, so assumptions could not be made about the impact of longerterm therapy. Although additional data were obtained from several authors, the manufacturers of minocycline, who sponsored many of the studies, failed to provide any of the requested information, despite an initial agreement . Subgroup analysis was also impossible due to the poor characterisation of participant groups and lack of adequate outcome data. It was also not possible to examine the impact of study design on the results, particularly with reference to the degree of blinding, as many studies were inconclusive.
How To Take Minocycline
The minocycline dose prescribed, how often to take it and for how long depends on what you’re taking it for. Always follow the instructions given by your doctor.
Minocycline standard tablets and capsules are usually taken twice a day, every 12 hours.
Minocycline modified-release 100mg capsules are taken once a day, at the same time each day. Do not open or chew these capsules, as this would damage the modified-release action.
Minocycline can be taken either with or without food, on a full or empty stomach. Swallow the tablets or capsules whole with plenty of water and don’t lie down just after taking a dose to avoid irritating the throat.
Don’t take indigestion remedies or medicines containing aluminium, calcium, iron, magnesium or zinc in the two hours before or after taking minocycline tablets or capsules. These can reduce the absorption of minocycline from the gut and make it less effective.
If you forget to take a minocycline dose, take it as soon as you remember, unless it’s nearly time for your next dose. In this case just leave out the missed dose and take your next dose as usual. Do not take a double dose to make up for a missed dose.
Finish the prescribed course of minocycline even if you feel better or it seems the infection has cleared up. Stopping the course early increases the chance that the infection will return and that the bacteria will grow resistant to the antibiotic.
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Overall Completeness And Applicability Of Evidence
Systematic reviewing is a retrospective study, and the conclusions are therefore dependent on the primary studies that have actually been conducted, are successfully identified, and then included. In order to prevent any bias arising from the inherent observational nature of the review, a strict systematic review protocol was developed prior to the onset of the review. This was not published as a Cochrane Protocol as this was not a requirement when the review was initially undertaken.
Two authors independently assessed each study. An exhaustive search was conducted and successfully located three unpublished RCTs, Cunliffe 1998 and Drake 1990 and Dreno 1998 , all of which met the inclusion criteria for the review. It is unlikely that any publication bias existed, as the majority of the studies failed to find any differences between the comparators. And any positive study, in either direction, would probably have been widelypublicised and cited in the retrieved studies. Language bias was avoided by inclusion of any RCT regardless of language of publication.
Appendix 6 Adverse Effects Search Strategy Embase
1. side effect$.ti,ab.9. .ti,ab.10. .ti,ab.15. treatment emergent.ti,ab.16. tolerability.ti,ab.17. adj3 ).ti,ab.18. rebound.ti,ab.21. exp postmarketing surveillance/22. exp drug surveillance program/23. exp drug hypersensitivity/ or exp hypersensitivity reaction/ or exp delayed hypersensitivity/ or exp hypersensitivity/ or exp immediate type hypersensitivity/24. exp drug eruption/29. exp respiratory tract allergy/30. exp urticaria/42. exp photodermatosis/ or exp photoallergy/43. exp burning mouth syndrome/44. exp drug monitoring/45. exp sleep apnea syndrome/46. exp heart arrhythmia/64. benign intracranial hypertension.ti,ab. or exp brain pseudotumor/65. exp pigment disorder/68. exp adverse drug reaction/69. exp drug safety/70. exp phase 4 clinical trial/71. .fs.73. 10118908.ti,ab.74. “7 dimethylamino 6 demethyl 6 deoxytetracycline”.ti,ab.75. .ti,ab.76. .ti,ab.77. or/727682. limit 81 to human
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Side Effects Of Minocycline For Acne
The primary issue with minocycline is its side effects.
Many people report side effects while taking minocycline. More side effects, in fact, than many of the other antibiotics in the same family. While all medications have their own risks, minocycline appears to have side effects that are more pronounced than other available options.
Common side effects of this medication include:
These side effects may be more common in minocycline than in other acne tetracycline medications. A not-insignificant amount of people taking minocycline for acne reported severe nausea and vomiting as a result of taking the drug.
Like other medications in the tetracycline family, minocycline also creates a sensitivity to light. This may result in easily burnable skin or in an allergic reaction to sunlight, known as photosensitivity. Sun bathing and extended periods of time in the sun without sunscreen is not advised.
An unusual side effect of minocycline is a blue/gray skin and tissues. Many people report blue or gray skin discoloration in their skin or gums. It can take a very long time for this blue color to fade.
In some cases, exposure to sun can cause a brown skin discoloration. This may be permanent.
Minocycline for acne has also been linked to more serious conditions like liver damage and hepatic lupus . These conditions are rare, but have been linked to both short and long term minocycline use.
Risk Of Bias In Included Studies
It is clear from the above description of the included trials that there was considerable variation between them with respect to numerous factors, which might affect study quality or introduce bias, or both. We sought further information from trial investigators when there was insufficient information in the trial report to make a judgement.
Only six of the RCT reports mentioned any specifics about how the randomisation was carried out and were rated as low risk of bias Ozolins 2005 Peacock 1990). The remainder of the included studies did not provide additional information beyond the fact that the study was randomised. One study matched pairs of participants in the treatment groups prior to randomisation on the basis of age, sex, and baseline acne severity . Pelfini 1989 and Waskiewicz 1992 were rated as high risk of bias. In Pelfini 1989, the trial design was compromised by a number of participants who were also given 5% benzoyl peroxide, which is very active. Also, two different treatments schedules and the method of randomisation was unclear and possibly based on severity. In Waskiewicz 1992, the investigators stated that three participants dropped out and were reincluded in the trial three to six months after their dropout. In the meantime, their acne did not improve spontaneously or with other treatments. The reinclusion of dropouts was judged to have compromised the randomisation.
Incomplete outcome data
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How To Use Minocycline For Acne
Minocycline is an oral prescription medication. It does not come in topical form, because the chemical itself tends to become damaged when it interacts with air and water. Pharmaceutical companies are trying to develop a minocycline topical treatment but have yet to have success.
Because of the side effects of minocycline, doctors recommend several techniques in order reduce the symptoms and improve absorption.
Note: Each minocycline drug comes with its own set of instructions. Review your doctor’s information and the pamphlet on how to use minocycline for acne that came with your medication. The following is simply a reference.
Generally, the minocycline dosing for acne is either 50 or 100mg tablets, taken once or twice a day. It’s recommended that you drink at least a full glass of water with the medication 8 ounces or more.
You should try taking minocycline without food. You can take it with food if you experience nausea or an upset stomach when taking minocycline, but this reduces the potential benefits of the medicine so it is not recommended.
Minocycline needs to be taken exactly as prescribed by your doctor to not only cure acne, but also to ensure that bacteria does not become resistant to the drug. Any variation in your dosing schedule can increase the likelihood of bacterial resistance.
Topical Minocycline For Acne: A Good Idea
All content found on Dermatology World Insights and Inquiries, including: text, images, video, audio, or other formats, were created for informational purposes only. The content represents the opinions of the authors and should not be interpreted as the official AAD position on any topic addressed. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
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Tips On Oral Antibiotics
Take your antibiotics regularly. The best way to cause the formation of resistant bugs is to skip dosages or to keep going on and off. Consistency is important even when it comes to the topical medications prescribed along with your oral antibiotics. If they appear not as effective just continue using them. They can help when the antibiotics are stopped.
How Does Minocycline Work
Acne occurs when the glands in your skin, called sebaceous glands, produce too much oil, called sebum. This excess amount of oil can clog the pores and lead to breakouts on your face or body. The bacteria, cutibacterium acnes, naturally occurs on the skin and with excessive growth, can cause and exacerbate your acne. When this occurs, doctors may prescribe a tetracycline antibiotic like minocycline or doxycycline.
Minocycline works by reducing the production of these bacteria cells which reside within your skins pores. By doing this, minocycline will reduce acne symptoms while also treating other bacterial infections that may occur because it is an antibiotic medication as well.
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Benefits Of Minocycline For Acne
Minocycline deals with acne by both killing germs and lowering inflammation. Minocycline only deals with active acne, not acne scars. Propionibacterium acnes is germs found on most peoples skin. Sometimes it builds up in your pores, triggering acne. Minocycline can kill the P.acnes. Minocycline also has anti-inflammatory properties, which can assist to lower soreness and swelling triggered by irritated acne. Your doctor may likewise prescribe an extra treatment, such as a topical acne cream, to be used with the minocycline.
What Are Tetracyclines And How Do They Work
Tetracyclines are a class of antibiotics that work against a variety of infections. Their anti-microbial actions have been reported even beyond their well-known effects on gram-positive and gram-negativebacterial infections caused by Chlamydiae, Mycoplasmas, Rickettsiae, and even some protozoal parasites. Although their action across many bacterial infections is very effective, they are not effective against viral infections.
Tetracycline interferes with the ability of the bacteria to produce certain vitalproteins required for bacterial growth. They target the ribosomal machinery within the bacteria that assembles proteins from amino acids. Due to this mode of action, tetracyclines inhibit bacterial growth rather than killing them. Tetracyclines prohibitproteinsynthesisin both human and bacterial cells. However, bacteria transport tetracyclines to their cell, whereas human cells do not. Human cells, therefore, are spared from the adverse effects of tetracycline.
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