The use of antibiotics to treat inflammatory skin conditions like acne and rosacea is decreasing, but there has been an increase in prescriptions associated with dermatologic surgical procedures, findings reported in a new study published in JAMA Dermatology by researchers at Penn’s Perelman School of Medicine. The results show some encouraging signs in the effort for greater antibiotic stewardship in dermatology, while also pointing to a clear need for further research. 

Dermatologists prescribe more antibiotics per provider than any other specialty—more than 7.1 million prescriptions per year. That number is further complicated by the fact that many patients, such as those taking antibiotics for acne, can stay on the drugs for extended periods of time, as opposed to other antibiotic uses that may only involve a seven- or 10-day course. The more antibiotics are used, the more the issue they are treating will build resistance. That reality has led to a renewed focus on stewardship across all fields of medicine, but dermatology has a particular onus given the field’s sheer volume of prescriptions.

“To track our field’s efforts, we wanted to know two things: In what settings do dermatologists prescribe antibiotics most frequently, and how is this use changing over time?” said the study’s lead author John Barbieri, dermatology research fellow. David J. Margolis, professor of dermatology, was the study’s senior author.

Researchers examined a commercial claims database of privately insured patients in the United States and looked at data from 2008 through 2016. During that time, overall dermatologic antibiotic prescriptions went from 3.36 per 100 visits to 2.13 per 100. The drop was especially notice- able in patients taking extended courses of antibiotics, which saw a 53.2 percent decrease from 2008 to 2016. This includes a 28.1 percent reduction in antibiotic prescriptions for acne.

During the same window, prescriptions for short courses of antibiotics increased. This was particularly driven by prescriptions associated with a surgical procedure, in which prescriptions increased 69.6 percent, from 3.92 prescriptions per 100 visits to 6.65 per 100. Prescribing associated with the diagnosis of cysts also went up 35.3 percent.

The study also found that while prescription rates are down overall, the duration and the type of antibiotic are both largely unchanged.