Minocycline Prescribing Patterns and Tolerability Mapped Across Indian Outpatient Records

Oral minocycline, a second-generation tetracycline antibiotic long used against acne and a range of infections, has been examined on an unusually large scale in Indian routine practice. A retrospective, real-world, observational study drew on anonymized electronic medical records (EMR) from the HealthPlix platform, covering private outpatient and specialty clinics across India between January 2017 and February 2023. Of 13,352 patients aged 12 years or older who were prescribed oral minocycline during that window, 2,161 patients from 189 centers had at least one documented follow-up visit and met the eligibility criteria. That follow-up requirement is important: it means the analyzed cohort represents roughly 16% of everyone who received a minocycline prescription on the platform, and the remaining patients simply lacked recorded follow-up within the network rather than being excluded for any clinical reason.

The cohort skewed young and female. The mean age was 30.15 years with a standard deviation of 12.50, and 78.67% of patients fell between 18 and 39 years of age. Women accounted for 62.56% of prescriptions (1,352 patients) versus 37.44% for men (809 patients). The authors note that this age and sex distribution mirrors the epidemiology of acne, which turned out to be the dominant reason the drug was prescribed. Similar patterns appear in earlier Indian epidemiological work, including a reported female majority in acne prevalence studies, so the demographic profile of the minocycline-treated population largely reflects who develops inflammatory skin disease rather than any prescribing bias toward a particular group.

Acne was documented as the indication for 1,230 patients, or 56.92% of the cohort, with acne vulgaris the most common subtype at 59.43% of those acne cases. Beyond acne, minocycline was prescribed for dermatitis (3.05%), folliculitis (2.45%) and secondary infections (1.43%), alongside a longer tail of other dermatologic and infectious diagnoses. This breadth is consistent with the drug’s pharmacology: minocycline is highly lipophilic, crosses lipid barriers readily, inhibits bacterial protein synthesis by binding the 30S ribosomal subunit, and carries anti-inflammatory effects that include suppression of neutrophil chemotaxis and matrix metalloproteinase activity. In India it has been approved by the Central Drugs Standard Control Organization since 1988 for urinary, respiratory, skin and soft tissue, ear, nose and throat infections and sexually transmitted infections, among others.

Dosing patterns showed clear preferences. Minocycline 100 mg once daily was the single most common regimen, prescribed to 648 patients (29.99%), with 100 mg as the most frequent dose strength overall (36.97%). The next most common regimen was 65 mg once daily (21.70%). An interesting exception emerged at the 50 mg strength, where twice-daily dosing (13.05% of all patients) was more popular than once-daily dosing (6.39%), in contrast to every other dose strength. Among patients with acne vulgaris specifically, 100 mg led (20.24%), followed by 65 mg (17.24%) and 45 mg (12.68%), while for acne of unspecified subtype, 50 mg was the leading strength. The mean duration of prescription among patients on the 100 mg once-daily regimen was 18.69 days, plus or minus 14.48.

Prescription duration clustered in short courses. The most common baseline prescription window was 11 to 20 days, covering 28.00% of the overall cohort and 33.17% of the acne subgroup, followed by 21 to 30 days in both groups (24.29% overall and 31.63% in acne). Longer courses of 31 to 60 days, 61 to 90 days and beyond 90 days appeared in smaller proportions. The authors interpret this short-course pattern as broadly aligned with contemporary guidance that favors the shortest effective use of systemic antibiotics, including recommendations to reassess systemic therapy at 6 to 8 weeks and limit total treatment duration. They also caution that the analysis captured only initial prescriptions, so some patients may have received additional courses at later visits, meaning total drug exposure could exceed what these baseline figures suggest.

Co-prescribing followed familiar acne treatment logic. Topical antibiotics were the most frequently co-prescribed medications (43.78% of patients), followed by retinoids and retinoid-based combinations (31.93%) and emollients and protectives (29.57%). Benzoyl peroxide was the most common single topical antibiotic agent (15.32%), and the adapalene-clindamycin combination led among retinoids (11.61%). Substantial minorities also received antifungal agents (14.35%), fluoroquinolone antibiotics (16.84%) and sunscreen (about 15%). This pattern closely mirrors expert recommendations that systemic tetracyclines in acne be coupled with topical therapies such as benzoyl peroxide and retinoids, partly to limit antibiotic resistance.

Adverse events were documented in just 29 patients, or 1.34% of the cohort. Hyperpigmentation was the leading event at 0.42% overall (9 patients) and 0.57% among acne patients (7 patients), followed by itching or pruritus at 0.37% (8 patients). Urticaria, dizziness, loose motions, myalgia and fatigue appeared less often. Crucially, the database contained no information on the severity or causality of these events, and the authors explicitly acknowledge that underreporting of mild or transient events cannot be excluded. For context, prior literature has reported adverse events in 13.6% of minocycline-treated patients, with hyperpigmentation in 3 to 15% and vestibular effects such as dizziness in 1 to 10%, so the figures here sit well below those historical ranges.

Effectiveness was assessed through clinician-documented terms indicating symptom resolution or improvement, such as pimples decreased, improving or resolving. Of the 2,161 patients, documented symptom resolution appeared in 160, all showing improvement at follow-up. Within the acne subgroup of 1,230 patients, resolution was captured in 143. These are strikingly low numbers relative to the cohort size, and the study itself explains why: documentation of improvement in routine outpatient settings is inconsistent, depends entirely on individual physician recording habits rather than standardized outcome measures, and partial or gradual responses may simply go unrecorded. Because many patients were simultaneously using topical agents and other co-prescribed medications, any improvement observed cannot be attributed to minocycline alone, and with no comparator group, no causal relationship between the drug and clinical outcomes could be established.

The limitations section is unusually candid and deserves weight when reading the headline numbers. Follow-up was confined to visits recorded within the HealthPlix network, so patients who switched providers or dropped out vanish from the record. Tolerability rested on physician-documented complaints without causality assessment, severity grading or exposure duration, and was not stratified by indication. Effectiveness lacked standardized severity scores and was evaluated only for the acne subgroup beyond the overall count. The study relied on prescriptions rather than confirmed dispensing or verified adherence. The retrospective design, absence of a comparator, and incomplete ascertainment of adherence, adverse events and clinical response mean the findings are primarily descriptive. Registered retrospectively with the Clinical Trials Registry-India (CTRI/2023/08/056338) and ethically approved with a consent waiver appropriate to fully deidentified data, the study nonetheless offers a useful, large-scale snapshot: in routine Indian outpatient care, oral minocycline was prescribed predominantly for acne in young adults, at doses and durations broadly consistent with recommendations, with few recorded adverse events among patients who returned for follow-up.

Subject of Research: A retrospective electronic medical records study of oral minocycline utilization, tolerability and effectiveness in Indian outpatient practice

Article Title: Tolerability, Drug Utilization Pattern and Effectiveness of Minocycline Oral Formulations in India: A Real-World Retrospective Study from Electronic Medical Records

Article References: Kandhari, S., Thomas, J., Yogiraj, K., SV, R., Pillai, R. T., Das, A., Shetty, G., Sheth, P., Lalan, B., Dharmadhikari, S., Khandhedia, C., Devkare, P., Mane, A., & Mehta, S. (2026). Tolerability, Drug Utilization Pattern and Effectiveness of Minocycline Oral Formulations in India: A Real-World Retrospective Study from Electronic Medical Records. Drugs – Real World Outcomes, 13(3), 487-497. https://doi.org/10.1007/s40801-026-00577-3

Image Credits: AI Generated

DOI: 10.1007/s40801-026-00577-3

Keywords: minocycline, acne, drug utilization, electronic medical records, real-world evidence, India, dermatology, tetracycline, adverse events, retrospective study, antibiotic prescribing, Tolerability