Oral antibiotic stewardship emphasized
Workgroup member Bethanee J. Schlosser, M.D, Ph.D., tells Dermatology Times that the most recent acne guidelines emphasize appropriate stewardship of oral antibiotics, including their recommended course, the importance of maintenance therapy and what defines maintenance therapy.
“In general, not just in dermatology, the Centers for Disease Control and Prevention has clearly been emphasizing throughout medicine that we want to be using the right antibiotic, for the right patient, for the right indication, for the right duration of time, to avoid development of antibiotic resistance,” says Dr. Schlosser, assistant professor, director, Women's Skin Health Program, department of dermatology, Northwestern University Feinberg School of Medicine, Chicago. “When you look across the board, dermatology is a significant percentage of antibiotic prescriptions, and acne accounts for a significant proportion of that.”
The guidelines recommend using oral antibiotics in patients with moderate-to-severe inflammatory acne. In essence, according to Dr. Schlosser, oral antibiotics are not meant for most patients with mild inflammatory acne, and these drugs are not appropriate for patients with comedonal acne.
The workgroup made a more specific recommendation that patients on antibiotics should be re-evaluated at three to four months to determine their continued need for the antibiotic. Although, the workgroup does acknowledge that there are select groups of patients that may require and benefit from a more prolonged course of oral antibiotics. Those are patients who are not eligible for other forms of therapy, including patients who may not be eligible combination oral contraceptives; patients who may not be candidates for oral isotretinoin due to other health issues; and patients who may not be able to tolerate topical agents.
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“Oral antibiotics should never be used as monotherapy for patients with acne,” Dr. Schlosser says. “… for patients that have moderate-to-severe inflammatory acne, dermatologists should still be using a topical retinoid in addition to the oral antibiotic.”
Dermatologists treating acne patients should advocate for benzoyl peroxide use in any patient who is on either a topical or an oral antibiotic. The data show that benzoyl peroxide used in conjunction with antibiotics decreases antibiotic resistance, according to Dr. Schlosser.