Researchers from the New York University Langone Medical Center found that doctors leave patients with severe acne to undergo ineffective antibiotic therapy far too long before starting them on isotretinoin, a more potent drug for acne treatment.
Systemic antibiotics are commonly administered to treat moderate to severe acne; however, due to the possibility that patients may develop resistance, priority is given to appropriate usage. In a new study, researchers aimed to identify how long patients with cystic acne undergo systemic antibiotic treatments before isotretinoin is required.
To perform the study, the researchers reviewed medical charts of patients with acne diagnostic codes, who went for a dermatologic consult from January 1, 2005 to December 31, 2014 in an academic institution. The participants were all recommended to undergo isotretinoin therapy within the course of the study and were administered with antibiotics for 30 days or more.
After analysis, the researchers found that the average period of antibiotic treatment was 331.3 days. Specifically, the duration of antibiotic use were three months or less for 21 patients (15.3 percent), six months or more for 88 patients (64.2 percent) and one year or more for 46 participants (33.6 percent).
The mean duration of the antibiotic use for patients who were solely treated at the institution was 283.1 days, while those who were prescribed by another facility with antibiotics had a mean duration of 380.2 days of use.
"Our study suggests that physicians need to recognize within weeks, not months, when patients are failing to respond to antibiotic therapy in cases of severe acne," said Dr Seth Orlow, the senior author of the study and the chairman of Ronald O. Perelman Department of Dermatology at the university.
Dermatologist Dr Arielle Nagler, the study's lead author, said that prolonged use of antibiotics and delayed prescription of isotretinoin may be due to associated side effects, as well as some federal limitations.
In the end, the researchers concluded that patients who subsequently take isotretinoin had prolonged exposure to antibiotics, far beyond the recommendations indicated in expert guidelines, which look after potential resistance.
"Early recognition of antibiotic failure and the need for isotretinoin can curtail antibiotic use," the authors wrote.
The study was published online in the Journal of the American Academy of Dermatology on Friday, Oct. 30.
Photo: Grégoire Lannoy | Flickr
