How long are you comfortable with keeping pediatric patients on oral antibiotics for acne?   

I usually won't do courses longer than 3 months without a next step or bridging option. Oftentimes, this is isotretinoin for males and spironolactone for females. I discuss with the guardian or parents that long-term antibiotic use is not ideal for the gut microbiome. Usually, this is well accepted,...

I feel the bridging option is a great idea unless the oral antibiotics are being highly effective per lesion count change. If they are being effective, there is no strong indication to change therapy unless we want to take a "drug holiday" to assess the need for treatment after 6-12 months.

I start all acne patients on a topical retinoid and if they need an oral antibiotic, I will prescribe that with a follow-up at 3 months. It takes about that long for a topical retinoid to kick in. If they need a couple of months longer, that's okay, but I might add topical or oral spironolactone to ...

I generally start with topical retinoids (initially with adapalene 0.1, moving up to Rx dose as tolerated), and if significant inflammatory lesions are present, I also start doxycycline or minocycline at a low anti-inflammatory dosage (40 or 50 mg daily). I believe there are too many downsides to us...