Dermatologists can and should play a larger role in antibiotic stewardship, according to researchers out of Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
Data from the CDC shows the average dermatology provider wrote 669 antibiotic prescriptions in 2014, the most recent year for which data are available. That is, by far, the highest average of any provider specialty. For some perspective, the next closest group was primary care physicians, who wrote an average of 483 prescriptions per provider.
One reason the numbers might be higher is that dermatologists prescribe antibiotics both as pills and topical medications. If a patient is doing well on oral antibiotics for acne, you tend to not want to stop it. In fact, a recent New York University study found the average patient who is on oral antibiotics for acne will stay on the medication for 331 days, essentially a full year.
What’s more, topical antibiotics can also have long term effects on the communities of bacteria that live on the skin, potentially opening the door for colonization by an unwanted strain.
These same drugs can also be used to treat community-acquired MRSA, Lyme disease, sexually transmitted diseases, and urinary tract infections. The stakes for resistance to these treatments are real. Even acne itself will become resistant over time.
Despite all of this data, dermatology remains in the background of the conversation on antibiotic stewardship.
Ebbing Lautenbach, MD, MPH, MSCE, chief of Infectious Diseases Perelman School of Medicine at the University of Pennsylvania, has a theory on why:
“A major focus of antibiotic stewardship is on areas where antibiotics aren’t called for, where a doctor might write the prescription without thinking about why and how they’re using it. That’s not usually the case in dermatology. [But] we need to distinguish between antibiotic use that is inappropriate or too long in duration and situations where a patient stays on a drug because it’s helping them.”
Lautenbach adds that physician education has been focused on the people who prescribe the most antibiotics. While, as noted above, dermatologists are prescribing more per practice, their total number of prescriptions pale in comparison to outpatient primary care doctors. That same CDC report found dermatologists wrote a total of 7.6 million prescriptions for antibiotics in 2014, while primary care physicians wrote 114.7 million.
“From an education standpoint, there tends to be more value in focusing our efforts on outpatient primary care prescribers,” Lautenbach says in a news release. “Dermatology isn’t where we find most use of antibiotics in terms of sheer volume.”