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November 11, 2015
Severe Acne Patients Are Left Too Long on
Ineffective Antibiotics

New York—Infefective antibiotics are prescribed too long for severe acne before more effective remedies are brought into play, according to a new study.

The medical records analysis, published online recently by the Journal of the American Academy of Dermatology, suggests that physicians delay too much before prescribing isotretinoin, formerly known as Accutane.

“Our study suggests that physicians need to recognize within weeks, not months, when patients are failing to respond to antibiotic therapy in cases of severe acne,” explained senior investigator Seth Orlow, MD, PhD, of NYU Langone Medical Center. For the study, researchers performed a detailed review of 137 medical histories of patients, 12 or older, who were treated at their facility for the severe skin condition between 2005 and 2014.

Orlow noted in an NYU Langone press release that the study is the first to focus specifically on the history of antibiotic overuse in severe cases of acne that later were more effectively treated.

Results indicate that patients with severe, often “cystic” acne were kept on initial antibiotic therapy for 11 months before their physicians recognized that the therapy was not working and switched them to isotretinoin.

Although the 137 patients eventually received isotretinoin, usually prescribed as a daily pill, it took a while. The researchers determined that there had been a lag of nearly 6 months on average from the time the therapy was first mentioned by the physician until patients began taking it.

In fact, the average duration of antibiotic use was 331.3 days. In all, 21 patients, 15.3%, were prescribed antibiotics for three months or less; 88 patients, 64.2%, for 6 months or more, and 46 patients, 33.6%, for a year or longer. Some of the delay was caused by tight controls placed on isotretinoin because of the increased risk for birth defects when used in pregnant women as well as concerns about depression and other potentially serious side effects, the authors note.

While antibiotic therapy can be effective for inflammatory types of acne and trying additional antibiotics is routine practice, clinical guidelines recommend limiting such antibiotic therapy to 2 months to 3 months each, or 6 months overall, unless significant improvements are seen.

“Physicians and patients have become far too complacent about antibiotic overuse and its subsequent danger of increasing microbial drug resistance,” Orlow pointed out. The problem is even worse, he noted, when patients frequently change physicians or health plans, which can lengthen ineffective antibiotic usage.

Lead investigator Arielle Nagler, MD, acknowledged that isotretinoin carries a real risk of side effects but said the protocols help prevent or carefully manage them.

In 2006, the FDA set up the iPledge registry, requiring all patients, physicians, and pharmacists to track isotretinoin prescriptions and side effects and to monitor compliance by women of child-bearing age with monthly pregnancy tests.

Registration delays or technical holdups often keep patients from getting their medications as prescribed by as much as a month, Nagler said.



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