‘Emerging need’ for alternative approaches to long-term antibiotic use in acne vulgaris

Key takeaways:

• Antibiotics were frequently used for longer than the 3- to 4-month duration recommended for acne treatment.
• Alternative approaches to long-term antibiotic use are needed for patients with acne.

Antibiotic use for the treatment of acne frequently extended beyond the duration of 3 to 4 months recommended by the American Academy of Dermatology, according to a study.

“The rationale behind studying acne and antibiotic use in this way was to be provide a current understanding of antibiotic prescribing in acne,” Raidah J. Salem, PharmD, of Almirall LLC, told Healio. “Former research in antibiotic prescribing in dermatology reflected a prevalence for dermatologist prescribing of antibiotics. With acne being the most common skin disease, the study focus is a practical next step to gaining a more robust real world understanding of the therapeutic management of acne.”

This is important because antibiotic resistance associated with prolonged use continues to be a public health concern.

In the retrospective assessment of trends in antibiotic use in acne, Salem and colleagues searched the IBM MarketScan claims database between January 2014 and September 2016.

Studies involving patients aged 9 years or older who had been diagnosed with acne vulgaris and had been prescribed an oral antibiotic were included.

The duration of oral antibiotic use longer than 12 months served as the primary endpoint. The group defined continuous use as treatment with a gap of 30 days or less between prescriptions.

“What is interesting about the study design is that it captures a real-world assessment of patient treatment history through retrospective analysis and robust patient criteria for inclusion,” Salem said. “Patients meeting inclusion criteria were also followed for over 18 months of continuous enrollment, in order to temporally associate their prescription of oral antibiotics with diagnosis of acne.”

Data for 46,267 oral antibiotic regimens were included.

Doxycycline prescriptions comprised 36.7% of these prescriptions, whereas 36.5% were minocycline prescriptions.

Continuous use of an oral antibiotic for 3 months was observed in 36% of the cohort. Further data showed that 18% used antibiotics continuously for 6 months, 10% for 9 months and 5% for 12 months.

Looking at specific medications, tetracyclines were prescribed continuously for 3 months in 40.2% of patients, whereas 18.6% were prescribed this class for 6 months, 10.5% for 9 months and 5.1% for 12 months.

For doxycycline, 34.7% of patients were prescribed this class continuously for 3 months, 14.6% for 6 months, 7.7% for 9 months and 3.9% for 12 months.

“As for results of the study and any surprises, I would not say it was a surprise, however it is interesting that the majority of treatment courses lasted for approximately 9 months, exceeding acne guideline recommendations for use,” Salem said. “These recommendations are considered to be a strategy in good antibiotic prescribing stewardship and here we see a continued patient need, providing an opportunity to consider alternatives to broad-spectrum antibiotics.”

Proportionally, more patients continuously used tetracyclines than any other therapeutic class, according to the findings.

The retrospective nature of the study and the relatively short duration are two key limitations.

“The overall take-home message of our study is a real-world representation within a body of evidence in acne treatments that prolonged use of oral antibiotics is a common patient need,” Salem said. “There is an emerging need to consider alternative approaches to systemic broad-spectrum antibiotics.”