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Dermatologists prescribe more oral antibiotics after surgical procedures

Increased use of postoperative courses of oral antibiotics prescribed by dermatologists after surgical procedures may put patients at risk for adverse events, according to a study.

Researchers from the University of Pennsylvania and the CDC completed a cross-sectional analysis of antibiotic prescribing practices by dermatologists from Jan. 1, 2008, to Dec. 31, 2016, using deidentified commercial claims data.

Claims were associated with the primary diagnosis from the most recent visit, and antibiotic courses were categorized as extended duration (more than 28 days) and short duration (28 days or less).

Over the study period, 985,866 courses of oral antibiotics were prescribed by 11,986 dermatologists. The most commonly prescribed antibiotics were doxycycline hyclate, minocycline and cephalexin.

Overall antibiotic prescribing from 2008 to 2016 decreased 36.6% from 3.36 courses per 100 visits with a dermatologist to 2.13. Prescribing courses of extended duration decreased 53.2% and short courses increased 8.4%.

Extended courses of therapy were most commonly associated with acne, rosacea and hidradenitis suppurativa. Antibiotic prescribing decreased by 28.1% for acne and by 18.1% for rosacea, while prescribing increased by 3.2% for hidradenitis suppurativa.

Short courses of antibiotic therapy were mostly associated with skin and soft tissue infections and surgical visits. Oral antibiotic use increased by 69.6% for surgical visits and 35.3% for cysts.

“Procedures in the groin, skin grafts, wedge excisions of the lip or ear, and procedures below the knee may be associated with higher surgical site infection risk, and single-dose perioperative antibiotics may help decrease the risk of surgical site infection for these higher risk cases,” the researchers wrote.

The overall frequency of antibiotic prescribing by dermatologists is declining, especially for extended courses, but the researchers said that the increasing use of postoperative antibiotics associated with surgical procedures is concerning because of the risk for antibiotic-resistant infections and antibiotic-associated adverse events. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.