Expert panel addresses key issues in antibiotic prescribing

November 1, 2006

In general, a fluoroquinolone should not be used empirically as first-line treatment in order to preserve the efficacy of that class of antibiotic when needed to treat gram-negative infections.

The SPAUD convened in April, 2006, was chaired by James Q. Del Rosso, D.O., and included dermatologists and specialists in infectious disease. In addition to Dr. Del Rosso, the panel included James Leyden, M.D., Guy Webster, M.D., Dirk Elston, M.D. and Jan Hirschmann, M.D.

"Optimizing antibiotic usage among dermatologists and addressing potential issues that may be clinically significant as opposed to those that may prove to be only of academic interest is an important initiative considering that our specialty writes about nine million prescriptions for antibiotics annually," says Dr. Del Rosso, clinical associate professor of dermatology, University of Nevada School of Medicine, Las Vegas.

AVOID MONOTHERAPY

One point of consensus that was recommended by the SPAUD panel is the avoidance of monotherapy with an oral or topical antibiotic for acne.

"Prescribers should remember that rational therapy for acne usually involves a combination regimen. Topical retinoids remain an important component of both initial and long-term treatment. Use of benzoyl peroxide concomitantly with an antibiotic can help reduce the risk of bacterial resistance, and is of particular value in patients who may need prolonged treatment with an antibiotic," Dr. Del Rosso tells Dermatology Times on behalf of the panel members.

"Topical clindamycin remains an effective agent for acne and is frequently used in combination with benzoyl peroxide to augment response and reduce emergence of less sensitive P. acnes strains," he adds.

With respect to treatment of skin and soft tissue infections, most of the uncomplicated infections treated by dermatologists in the outpatient setting are caused by methicillin-susceptible staphylococci or streptococci and can be treated effectively with a variety of conventional antibiotic agents. Oral cephalosporins active against those pathogens are the most commonly used option by dermatologists and include both cephalexin and cefdinir. In general, a fluoroquinolone should not be used empirically as first-line treatment in order to preserve the efficacy of that class of antibiotic when needed to treat gram-negative infections.

While skin infections caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) have become an increasing problem and are not eradicated by the commonly used cephalosporins, the panel noted CA-MRSA skin infections usually present as abscesses and often respond to incision and drainage, regardless of antibiotic choice.

"A specimen may be obtained for culture and sensitivity, but even if CA-MRSA infection is confirmed, systemic antibiotic therapy directed against CA-MRSA is not as important as incision and drainage," Dr. Del Rosso says.