Trends in Oral Antibiotic Prescription in Dermatology, 2008 to 2016

Abstract

IMPORTANCE Dermatologists prescribe more oral antibiotic courses per clinician than any other specialty, and this use puts patients at risk of antibiotic-resistant infections and antibiotic-associated adverse events. OBJECTIVE To characterize the temporal trends in the diagnoses most commonly associated with oral antibiotic prescription by dermatologists, as well as the duration of this use. DESIGN, SETTING, AND PARTICIPANTS Repeated cross-sectional analysis of antibiotic prescribing by dermatologists from January 1, 2008, to December 31, 2016. The setting was Optum Clinformatics Data Mart (Eden Prairie, Minnesota) deidentified commercial claims data. Participants were dermatology clinicians identified by their National Uniform Claim Committee taxonomy codes, and courses of oral antibiotics prescribed by these clinicians were identified by their National Drug Codes. EXPOSURES Claims for oral antibiotic prescriptions were consolidated into courses of therapy and associated with the primary diagnosis from the most recent visit. Courses were stratified into those of extended duration (>28 days) and those of short duration (Յ28 days). MAIN OUTCOMES AND MEASURES Frequency of antibiotic prescribing and associated diagnoses. Poisson regression models were used to assess for changes in the frequency of antibiotic prescribing over time. RESULTS Between 2008 and 2016 among 985 866 courses of oral antibiotics prescribed by 11 986 unique dermatologists, overall antibiotic prescribing among dermatologists decreased 36.6% (1.23 courses per 100 visits) from 3.36 (95% CI, 3.34-3.38) to 2.13 (95% CI, 2.12-2.14) courses per 100 visits with a dermatologist (prevalence rate ratio for annual change, 0.931; 95% CI, 0.930-0.932), with much of this decrease occurring among extended courses for acne and rosacea. Oral antibiotic use associated with surgical visits increased 69.6% (2.73 courses per 100 visits) from 3.92 (95% CI, 3.83-4.01) to 6.65 (95% CI, 6.57-6.74) courses per 100 visits associated with a surgical visit (prevalence rate ratio, 1.061; 95% CI, 1.059-1.063). CONCLUSIONS AND RELEVANCE Continuing to develop alternatives to oral antibiotics for noninfectious conditions, such as acne, can improve antibiotic stewardship and decrease complications from antibiotic use. In addition, the rising use of postoperative antibiotics after surgical visits is concerning and may put patients at unnecessary risk of adverse events. Future studies are needed to identify the value of this practice and the risk of adverse events.

<p>Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience</p>

“…The indication for and duration of systemic antibiotics should be limited, particularly when effective alternatives are available. 22…”

Use of Antibiotics for Dermatologic Procedures From 2008 to 2016

“…Although overall oral antibiotic use among dermatologists is declining, antibiotic prescribing by dermatologists associated with benign excisions, malignant excisions, and Mohs surgery has been increasing over the past decade and there is substantial geographic variation in antibiotic use. 10 These prolonged courses of postoperative antibiotics may place patients at unnecessary risk of adverse outcomes without providing additional value with respect to prevention of postoperative complications. Given the substantial geographic variation in practice patterns, there are likely opportunities to optimize antibiotic use associated with dermatologic procedures to improve patient outcomes.…”

“…Although use of oral antibiotics for chronic inflammatory conditions such as acne and rosacea appears to be decreasing, use of oral antibiotics associated with dermatologic procedures has increased substantially over the past decade. 10 In addition, a 2012 survey 11 sent to American College of Mohs Surgery members found that there may be antibiotic overuse associated with dermatologic procedures. However, factors associated with oral antibiotic use, differences in use between procedure types, and geographic variation in prescribing practices have not been well characterized.…”

Sarecycline Review

“…Dermatologists are the most common prescribers of oral antibiotics in the United States, and extended courses of antibiotics are commonly prescribed for inflammatory conditions such as acne, rosacea, and hidradenitis suppurativa. 20,21 Oral antibiotics are useful when treating moderate to severe inflammatory acne that is refractory to topical therapy. 12 The tetracycline family of antibiotics is considered the first-line systemic antibiotic treatment for acne.…”