Philadelphia—Pharmacists might have noticed that dermatologists prescribe more oral antibiotic courses per clinician than any other specialty. A new study looked at changes in prescribing patterns over time for skin diseases.
The article in JAMA Dermatology points out the clinical consequences in addition to the development of antimicrobial resistance. For example, according to the report, oral antibiotic therapy in the treatment of acne is associated with disruption of the normal oropharyngeal flora and resultant pharyngitis, while using tetracycline-class antibiotics might also be linked with the development of inflammatory bowel disease and collagen vascular diseases. The study team also notes that chronic antibiotic use is suspected to be a factor in increased risk of colon and breast cancer, which is thought to be mediated through disruption of the microbiome.
The good news from University of Pennsylvania Perelman School of Medicine–led researchers is that between 2008 and 2016 among 985,866 courses of oral antibiotics prescribed by 11,986 unique dermatologists, overall antibiotic prescribing decreased from 3.36 to 2.13 courses per 100 visits. At the same time, however, antibiotic scripts increased associated with surgical visits from 3.92 to 6.65 courses per 100 visits.
The repeated cross-sectional analysis of antibiotic prescribing by dermatologists from January 1, 2008, to December 31, 2016, used Optum Clinformatics Data Mart deidentified commercial claims data. Dermatology clinicians identified by their National Uniform Claim Committee taxonomy codes were participants, and courses of oral antibiotics prescribed by those clinicians were identified by their National Drug Codes.
With claims for oral antibiotic prescriptions consolidated into courses of therapy and associated with the primary diagnosis from the most recent visit, antibiotic courses were stratified into those of extended duration of more than 28 days and short duration of 28 days or fewer.
Results indicate that 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). Researchers explain that much of the decrease occurred among extended courses for acne and rosacea.
On the other hand, they report, 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).
“Continuing to develop alternatives to oral antibiotics for noninfectious conditions, such as acne, can improve antibiotic stewardship and decrease complications from antibiotic use,” study authors conclude. “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.”
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The article in JAMA Dermatology points out the clinical consequences in addition to the development of antimicrobial resistance. For example, according to the report, oral antibiotic therapy in the treatment of acne is associated with disruption of the normal oropharyngeal flora and resultant pharyngitis, while using tetracycline-class antibiotics might also be linked with the development of inflammatory bowel disease and collagen vascular diseases. The study team also notes that chronic antibiotic use is suspected to be a factor in increased risk of colon and breast cancer, which is thought to be mediated through disruption of the microbiome.
The good news from University of Pennsylvania Perelman School of Medicine–led researchers is that between 2008 and 2016 among 985,866 courses of oral antibiotics prescribed by 11,986 unique dermatologists, overall antibiotic prescribing decreased from 3.36 to 2.13 courses per 100 visits. At the same time, however, antibiotic scripts increased associated with surgical visits from 3.92 to 6.65 courses per 100 visits.
The repeated cross-sectional analysis of antibiotic prescribing by dermatologists from January 1, 2008, to December 31, 2016, used Optum Clinformatics Data Mart deidentified commercial claims data. Dermatology clinicians identified by their National Uniform Claim Committee taxonomy codes were participants, and courses of oral antibiotics prescribed by those clinicians were identified by their National Drug Codes.
With claims for oral antibiotic prescriptions consolidated into courses of therapy and associated with the primary diagnosis from the most recent visit, antibiotic courses were stratified into those of extended duration of more than 28 days and short duration of 28 days or fewer.
Results indicate that 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). Researchers explain that much of the decrease occurred among extended courses for acne and rosacea.
On the other hand, they report, 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).
“Continuing to develop alternatives to oral antibiotics for noninfectious conditions, such as acne, can improve antibiotic stewardship and decrease complications from antibiotic use,” study authors conclude. “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.”
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