Oracea called best nonantibiotic Tx for rosacea: the once-daily, 40-mg, controlled-release dose falls below doxycycline's threshold of antibiotic activity.(Clinical Rounds)

KOLOA, HAWAII -- With marketing approval of the anti-inflammatory, nonantibiotic formulation of doxycycline for treatment of rosacea widely anticipated by the end of this month, this new once-daily oral agent is likely to be viewed as the best therapeutic option for patients with papulopustular forms of the disease, Dr. Hilary E. Baldwin said at the annual Hawaii dermatology seminar sponsored by the Skin Disease Education Foundation.

It has long been recognized that conventional antibiotics--particularly those in the tetracycline class--are highly effective in rosacea, even though it is now clear that the disease isn't actually caused by bacteria.

However, long-term use of antimicrobials to treat a chronic disease such as rosacea, which may last for decades, is increasingly seen as irresponsible because it contributes to the rise of antibiotic-resistant, highly pathogenic bacteria.

"This is not a minor problem. It's not something that people are making up. It's a truly global-impact problem. And by treating a nonbacterial disease with antibiotics, we're adding to the problem," stressed Dr. Baldwin of the State University of New York, Brooklyn.

Fortunately, physicians have access to a range of nonantibiotic alternatives in treating rosacea. The best of them could be Oracea: Its once-daily micro-dose formulation of doxycycline is far cheaper than lasers, devoid of the teratogenicity concerns posed by oral and topical retinoids, and far more effective than [beta]-blockers and other antiflushing medications, she said.

Here's a rundown of the nonantibiotic alternatives:

* Oracea. Food and Drug Administration approval is anticipated for this agent as a 40-mg controlled release drug indicated for treatment of rosacea. Its big selling point--in addition to the efficacy--is that this dose lies below the drug's threshold of antibiotic activity. Hence, there are no concerns regarding the emergence of bacterial resistance.