It is important to discuss and educate patients on the potential side effects of each antibiotic in order to maximize patient compliance. Patients may express several concerns about oral antibiotic use. One of these concerns may be possible reduced efficacy of their oral contraceptives. No pharmacokinetic interaction has been demonstrated between oral contraceptive pill and antibiotics (except rifampin). Oral contraceptive failure rates while on antibiotics, including those used for treating acne, fall within the range of oral contraceptive failure rates of patients not on antibiotics which is 1% to 3% (73). There are some individuals who will have decreased absorption of the oral contraceptive due to changes in the gut flora by antibiotics. It is impossible to predict who these patients will be. Therefore, all patients should be counseled regarding the small risk that their oral contraceptive may be less effective while taking antibiotics. Patients may also express concern regarding the publicized cancer risk with antibiotic use. A study in 2004 showed an increased risk of breast cancer with long-term antibiotic use (74). This risk was the same if antibiotics were being used to treat acne/rosacea or respiratory tract infections. A direct effect was not demonstrated in this study, only an association. It is important to point out to patients that no causal relationship between antibiotic use, and breast cancer was identified in this study.
Frequently antibiotics produce favorable results but sometimes a patient does not respond to antibiotic treatment. Several reasons exist for a poor clinical response. The antibiotic may have been given at an inadequate dose or for an inadequate duration. A maximum response is usually seen in three to four months. The patient may have been given suboptimal instructions on use or had poor compliance. Patients with a high sebum excretion rate (greater than 2.5 micrograms/cm/minute) may not respond due to dilution of the antibiotic in the pilosebaceous unit. Antibiotics may not be helpful if the patient is misdiagnosed with acne when the eruption truly is folliculitis due to gram negative enterobacteria, staphylococci, or yeasts.