Patients with moderate to severe acne may be receiving antibiotics for much longer than recommended.
Prior to eventually being commenced on oral Isotretinoin for moderate to severe acne, many patients are being prescribed antibiotics for much longer than is recommended. A recent report in the Journal of the American Academy of Dermatology (JAAD) indicated that the average duration of antibiotic use was 331.3 days for patients with inflammatory/nodulocystic acne who eventually required treatment with oral Isotretinoin.
The study focused on the prescribing habits of dermatologists and general practitioners. The study noted that 64% of patients were prescribed oral antibiotics for 6 months or more and over 33% were prescribed oral antibiotics for 12 months or longer. Most patients eventually required oral Isotretinoin to adequately control their acne.
An important issue raised in the study is the threat of antibiotic resistance, particularly to Propionibacterium acnes. It was highlighted that recognising early those patients who fail to respond to antibiotics and earlier prescription of Isotretinoin would have a significant impact on over-prescribing of antibiotics for acne. Many experts have recommended that antibiotic use in acne be limited to approximately 3 months, with treatment courses of antibiotics greater than 6 months likely to induce bacterial resistance.
If antibiotics fail to clear acne after 3 or 4 months to a level that control can be maintained by topical treatments, then consideration should be given to starting oral Isotretinoin.
It is recommended that prescribing doctors be reminded of the risk of long term antibiotic prescribing, particularly where multiple courses are offered to patients, and a complete antibiotic history should be elicited from patients or practice records. Timely initiation of Isotretinoin should be considered if appropriate and discussed with patients earlier in the treatment cycle, particularly where acne fails to improve significantly with shorter courses of oral antibiotics.
Nagler, AR et al. The use of oral antibiotics before Isotretinoin therapy in patients with acne. J Am Acad Dermatology. 2015