John S Barbieri1, Ole Hoffstad2, David J Margolis3. 1. Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: john.barbieri@uphs.upenn.edu. 2. Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 3. Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: Guidelines recommend limiting the duration of oral antibiotic therapy in acne to 3 to 6 months and prescribing concomitant topical retinoids for all patients. OBJECTIVE: We sought to evaluate the duration of therapy with oral tetracyclines and the use of topical retinoids among patients with acne treated primarily by general practitioners in the United Kingdom. METHODS: We conducted a retrospective cohort study using the Health Improvement Network database. RESULTS: The mean duration of therapy was 175.1 days. Of antibiotic courses, 62% were not associated with a topical retinoid; 29% exceeded 6 months in duration. If all regions were to achieve uses similar to the region with the shortest mean duration of therapy, approximately 3.3 million antibiotic days per year could be avoided in the United Kingdom. LIMITATIONS: The Health Improvement Network does not include information on acne severity and clinical outcomes. CONCLUSIONS: Prescribing behavior for oral antibiotics in the treatment of acne among general practitioners is not aligned with current guideline recommendations. Increasing the use of topical retinoids and considering alternative agents to oral antibiotics when appropriate represent opportunities to reduce antibiotic exposure and associated complications such as antibiotic resistance and to improve outcomes in patients treated for acne.
BACKGROUND: Guidelines recommend limiting the duration of oral antibiotic therapy in acne to 3 to 6 months and prescribing concomitant topical retinoids for all patients. OBJECTIVE: We sought to evaluate the duration of therapy with oral tetracyclines and the use of topical retinoids among patients with acne treated primarily by general practitioners in the United Kingdom. METHODS: We conducted a retrospective cohort study using the Health Improvement Network database. RESULTS: The mean duration of therapy was 175.1 days. Of antibiotic courses, 62% were not associated with a topical retinoid; 29% exceeded 6 months in duration. If all regions were to achieve uses similar to the region with the shortest mean duration of therapy, approximately 3.3 million antibiotic days per year could be avoided in the United Kingdom. LIMITATIONS: The Health Improvement Network does not include information on acne severity and clinical outcomes. CONCLUSIONS: Prescribing behavior for oral antibiotics in the treatment of acne among general practitioners is not aligned with current guideline recommendations. Increasing the use of topical retinoids and considering alternative agents to oral antibiotics when appropriate represent opportunities to reduce antibiotic exposure and associated complications such as antibiotic resistance and to improve outcomes in patients treated for acne.
Authors: Anna L Chien; Jerry Tsai; Sherry Leung; Emmanuel F Mongodin; Amanda M Nelson; Sewon Kang; Luis A Garza Journal: JAMA Dermatol Date: 2019-04-01 Impact factor: 10.282
Authors: Ines B Moura; Ayman Grada; William Spittal; Emma Clark; Duncan Ewin; James Altringham; Emilio Fumero; Mark H Wilcox; Anthony M Buckley Journal: Front Microbiol Date: 2022-05-31 Impact factor: 6.064
Authors: John S Barbieri; Ketaki Bhate; Kathleen P Hartnett; Katherine E Fleming-Dutra; David J Margolis Journal: JAMA Dermatol Date: 2019-03-01 Impact factor: 10.282
Authors: Ketaki Bhate; Liang-Yu Lin; John Barbieri; Clémence Leyrat; Susan Hopkins; Richard Stabler; Laura Shallcross; Liam Smeeth; Nick A Francis; Rohini Mathur; Sinéad M Langan; Sarah-Jo Sinnott Journal: BMJ Open Date: 2020-07-02 Impact factor: 2.692
Authors: Ketaki Bhate; Liang-Yu Lin; John S Barbieri; Clémence Leyrat; Susan Hopkins; Richard Stabler; Laura Shallcross; Liam Smeeth; Nick Francis; Rohini Mathur; Sinéad M Langan; Sarah-Jo Sinnott Journal: BJGP Open Date: 2021-06-30