Trends in Prescribing Antibiotics for Acne Contradict Guidelines

Earlier recognition of antibiotic failure and the transition to isotretinoin can help to prevent overuse of antibiotics among patients with inflammatory or nodulocystic acne, according to a recent study.

Although guidelines recommend that patients take antibiotics for 3 months and then use topical therapy, antibiotics are frequently used for much longer, causing skin bacteria to become resistant.

To conduct their study, researchers reviewed medical charts of all patients with acne diagnostic codes who visited a single dermatology center from January 1, 2005, to December 31, 2014.
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Patients included in the review had been prescribed isotretinoin during the study period and 30 days or more of antibiotics.

After analyzing the data, researchers found that only 15% of patients (n=21) were prescribed antibiotics following guideline recommendations, whereas 64% (n=88) took antibiotics for 6 months or more and 34% (n=46) took antibiotics for 1 year or longer.

Patients who received antibiotics at the dermatology center took antibiotics for a mean duration of 281.3 days. Those who were prescribed antibiotics from another center took them for a mean duration of 380.2 days.

“Expert guidelines recommend responsible use of antibiotics in acne in light of emerging resistance,” researchers concluded. “We found that patients who eventually received isotretinoin had extended exposure to antibiotics, exceeding recommendations. Early recognition of antibiotic failure and the need for isotretinoin can curtail antibiotic use.”

—Amanda Balbi

Reference:
Nagler AR, Milam EC, Orlow SJ. The use of oral antibiotics before isotretinoin therapy in patients with acne. J Am Acad Dermatol. 2016;74(2):273-279. doi:http://dx.doi.org/10.1016/j.jaad.2015.09.046.