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Dermatologists prescribing more antibiotics following surgical visits

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January 17, 2019

Antibiotic prescribing by dermatologists has “substantially decreased” in recent years, mostly due to a drop in prescriptions for acne and rosacea, but they are prescribing more antibiotic courses following surgical visits, a practice that should be evaluated, researchers said.

“Antibiotic resistance is a growing concern both for the effectiveness of therapies for dermatologic disease and for the treatment of infectious diseases. Dermatologists prescribe more oral antibiotic courses per clinician than any other specialty, and many of these courses of antibiotics are prescribed for several months in duration,” John S. Barbieri, MD, MBA, dermatologist and postdoctoral research fellow at the University of Pennsylvania Perelman School of Medicine, and colleagues wrote.

“Oral antibiotics are frequently used for acne, rosacea, and other inflammatory conditions due to their potential anti-inflammatory properties. In addition, dermatologists also prescribe perioperative and postoperative oral antibiotics to prevent surgical complications. This antibiotic use can have clinical consequences, including the development of antimicrobial resistance.”

Barbieri and colleagues explained that although antibiotics are prescribed for a variety of conditions, the frequency and duration of use of oral antibiotics for conditions other than acne have not been well characterized. For their study, they used commercial claims data to analyze dermatologists’ prescribing practices between Jan. 1, 2008, and Dec. 31, 2016.

Results of the study showed that between 2008 and 2016, 985,866 courses of oral antibiotics were prescribed by 11,986 dermatologists. During the study period, overall antibiotic prescribing decreased 36.6% from 3.36 to 2.13 courses prescribed per 100 visits. The majority of this decrease was for extended courses for acne and rosacea, Barbieri and colleague reported. But they also found that oral antibiotic use associated with surgical visits increased 69.6% from 3.92 to 6.65 courses per 100 visits.

“While dermatologists were once the most frequent prescribers of antibiotics per clinician, the prescribing of antibiotics by dermatologists is declining, particularly for extended courses of antibiotics given to patients with chronic dermatologic conditions, such as acne and rosacea. Opportunities may exist to improve antibiotic stewardship further, and the CDC has developed a framework for improved antibiotic stewardship in the outpatient setting,” the authors concluded.

“There is rising use of prolonged postoperative courses of antibiotics associated with visits for surgical procedures, which may put patients at unnecessary risk of adverse events, given the available evidence and guideline recommendations. Future studies are needed to identify the value of this practice with respect to patient outcomes and antibiotic stewardship.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.

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