Views of oral antibiotics and advice seeking about acne: a qualitative study of online discussion forums

Summary Background Acne vulgaris is common and can significantly impair quality of life, yet little is known about patients’ understanding of acne and its treatments. Oral antibiotics are widely used for acne despite concerns about antibiotic resistance. People are increasingly turning to online discussion forums for advice, and information on these sites may influence health beliefs and treatment adherence. Objectives To explore understandings about the use of oral antibiotics for acne and advice shared among messages posted on online forums. Methods We systematically searched for online forums and identified four where acne was frequently discussed. Discussion threads relating to oral antibiotics were analysed thematically. Results We extracted 136 pages of data comprising 65 discussions among 294 participants. We found a wide range of perceptions around effectiveness of antibiotics for acne and concerns about adverse effects. The delayed onset of action of antibiotics was a source of frustration and compounded dissatisfaction with healthcare providers, who were perceived by people as ‘fobbing them off’ with prolonged courses of ineffective treatment. Advice ranged from when to ask for or insist on referral to use of costly cleansers. Forum posts related to a wide range of severities, from ‘spots’ to severe acne, which may make it confusing for users to assess appropriateness of information. Conclusions Online forums offer opinions that could confuse patients, or lead to early abandonment of treatments, challenging consultations and patient dissatisfaction. Users expressed frustration about the delayed onset of action of antibiotics for acne, perceptions of only temporary effectiveness and adverse effects. What's already known about this topic? Acne vulgaris is very common and can have considerable impact on quality of life. Although some information is available about patients’ views of oral isotretinoin, little is known about views and experiences of the most common treatments for acne, including oral antibiotics. Online discussion forums are an increasingly common source of information about health conditions, yet we know little about the advice exchanged online about acne. What does this study add? We found very diverse views about oral treatments in general and oral antibiotics in particular. Sources of frustration included the delayed onset of action of antibiotics for acne, perceptions of only temporary effectiveness and adverse effects. Advice on