Dermatologist aims to define antibiotic management

Dermatologists addressed antibiotic overprescription with an editorial article published in JAMA Dermatology. The need for antibiotics is widely recognized, however, overprescribing practices contribute to the emergence of antibiotic resistance and increase the risk of resistant infections and treatment failures.

In the article, Margaret MacGibeny, MD, PhD, Jay-Hyun Jo, PhD, and Heidi Kong, MD, MHSc, Cutaneous Microbiome and Inflammation Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health , said that although there has been an overall decrease in antibiotic prescribing over the past decade, American dermatologists continue to prescribe these treatments at higher rates than clinicians in other specialties.

“Dermatologists are essential players in antibiotic stewardship efforts and play a critical role in optimizing antibiotic use,” they wrote.

The research

The authors referenced a cross-sectional analysis of prescribing trends among US dermatologists from 2008 to 2016 that found tetracyclines to be the most frequently prescribed antibiotics. Cephalexin and trimethoprim-sulfamethoxazole (TMP-SMX) have also been reported as commonly prescribed.

Inflammatory skin diseases such as acne and rosacea were associated with prolonged antibiotic regimens (greater than 28 days), while regimens for infections and surgical visits were associated with short antibiotic courses (median 7-14 days).

Prescribing for long-term use for acne and rosacea has declined in recent years according to reviews, but the authors mentioned a worrying increase in short courses following surgical visits. Ultimately, the need for further optimization of antibiotics is supported by these data.

Additionally, antibiotics have the ability to alter skin microbial communities, which has been demonstrated in studies that have revealed a change in the composition and diversity of the human skin microbiome as a result of systemic antibiotics.

Complementary survey on the management of antibiotics

According to one analysis, significant patient changes were seen in those who received doxycycline or TMP-SMX compared to those who did not. Since the skin is a host environment for microbes of all kinds, it may also be associated with emerging drug-resistant microbes.

For this reason, the authors argued that it is critical that dermatologists incorporate antibiotic stewardship principles into prescribing practices. The CDC has even emphasized potential alternative treatment options for high-priority conditions.

The goal of eliminating unnecessary antibiotic use is important to the potential limitations of non-antibiotic therapies. The authors noted guidelines for non-antibiotic therapies that are currently limited due to the lack of prospective randomized clinical trials comparing the effectiveness of systemic antibiotics versus alternative treatments for dermatological conditions.

“In summary, the optimal approach to antibiotic prescribing in dermatology involves a risk-benefit analysis,” the authors wrote. “To achieve the most effective results, dermatologists should consider all treatment options. By integrating antibiotic stewardship principles into prescribing practices, dermatologists can optimize the appropriate use of antibiotics while limiting the development and spread antimicrobial resistance and minimizing antibiotic-associated complications.”

The article “Antibiotic Stewardship in Dermatology—Reducing the Risk of Prolonged Antimicrobial Resistance in Skin” was published in JAMA Dermatology.

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