Dermatologists Still Prescribe More Antibiotics Than Any Other Specialists

antibiotics

Although overall dermatologic antibiotic prescribing has dropped by 36.6% within the last decade, dermatologists still prescribe the most antibiotics compared with clinicians in any other specialty, a new study suggests.1

Researchers say there is still room for improvement in some areas of dermatologic antibiotic prescribing. Short-term prescriptions associated with surgical visits topped the list, increasing by 69.6% between 2008 and 2016, whereas the largest decrease in dermatologic antibiotic prescribing was observed for extended courses (more than 28 days) for acne and rosacea.
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“Overall, our findings are hopefully a sign that we’re making progress, but we need to evaluate how we can optimize the use of antibiotics in dermatologic surgery,” said lead author John Barbieri, MD, dermatology research fellow at the University of Pennsylvania Perelman School of Medicine, in a press release.2

Barbieri and colleagues arrived at their conclusion after conducting a repeated cross-sectional analysis of antibiotic prescribing by dermatologists from January 1, 2008, to December 31, 2016. They identified 985,866 oral antibiotic courses prescribed by 11,986 unique dermatologists during this time period using Optum Clinformatics Data Mart de-identified commercial claims data, National Uniform Claim Committee taxonomy codes, and National Drug Codes.

Overall dermatologic prescribing had decreased from 3.36 to 2.13 courses per 100 visits with a dermatologist (prevalence rate ratio for annual change: 0.931) from 2008 to 2016, but oral antibiotic use associated with surgical visits had risen from 3.92 to 6.65 courses per 100 visits associated with a surgical visit (prevalence rate ratio: 1.061).

Dr Barbieri and colleagues said continued development of alternatives to antibiotics for noninfectious conditions can help improve stewardship and decrease patients’ risk of antibiotic-resistant infections and antibiotic-associated adverse events.

However, “this is not to say we should quit prescribing antibiotics ‘cold turkey’ for all patients undergoing procedures,” wrote Joslyn S. Kirby, MD, MS, Med, and Jordan S. Lim, MB Bch BAO, of the Department of Dermatology at Penn State Hershey, in an accompanying editorial.3

Clinicians should adhere to existing recommendations for antibiotic use, including postoperative indications, Dr Barbieri and colleagues wrote.

—Christina Vogt

References

1. Barbieri JS, Bhate K, Hartnett KP, Fleming-Dutra KE, Margolis DJ. Trends in oral antibiotic prescription in dermatology, 2008 to 2016 [Published online January 16, 2019]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.4944.

2. Dermatologists prescribe the most antibiotics, but which uses are driving the trend? [press release]. Philadelphia, PA. Penn Medicine. January 16, 2019. https://www.pennmedicine.org/news/news-releases/2019/january/dermatologists-prescribe-the-most-antibiotics-but-which-uses-are-driving-the-trend. Accessed on January 16, 2019.

3. Kirby JS, Lim JS. Dermatologists and antibiotics- reflecting on our habits, the evidence, and next steps [Published online January 16, 2019]. JAMA Dermatol.