Patients with severe acne often remained on antibiotics longer than recommended before beginning treatment with isotretinoin, in a retrospective chart review of patients treated for acne at New York University.
The medical records analysis of 137 patients with severe acne who eventually received isotretinoin found that the average duration of antibiotic use in these patients was 331.3 days, far exceeding expert recommendations to limit use to 3 months, reported Dr. Arielle R. Nagler and her associates in the department of dermatology, New York University.
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In total, 15.3% of patients in the study were treated with antibiotics for 3 months or less, and 64.2% were treated with antibiotics for 6 months or longer. Almost 34% were treated with antibiotics for 1 year or longer.
The mean time elapsed between the first recorded mention of possible isotretinoin use and actual initiation of treatment was 155.8 days, Dr. Nagler and her colleagues reported. The mean age of initiation of isotretinoin was 19.6 years.
“Prolonged courses of systemic antibiotics are discouraged for several reasons including increasing resistance of P. acnes [Propionibacterium acnes] to antibiotics,” the authors wrote. “Courses 6 months or longer are highly likely to induce resistance.”
Patients who received antibiotic treatment only at the study site took antibiotics for a mean duration of 283.1 days, whereas those treated at multiple institutions had a mean duration of 380.2 days, they added (P = .054).
“Dermatologists should be aware that patients presenting to them who have been cared for by other providers are at particular risk for extended courses of antibiotics,” they said.
To help reduce unnecessary antibiotic use, providers should recognize patients who are not improving after 6-8 weeks, and consider starting isotretinoin therapy “at an earlier time point, especially in those with severe acne,” Dr. Nagler and her coauthors advised.
Read the full report in the Journal of the American Academy of Dermatology.