Dermatologist Aim to Define Antibiotic Stewardship

Margaret MacGibeny, MD, PhD

Dermatologists addressed the overprescribing of antibiotics with an editorial article published in JAMA Dermatology. The necessity of antibiotics is widely understood, however, excessive prescribing practices contribute to the emergence of antibiotic resistance and furthers a patient's risk for resistant infections and treatment failures.

In the article, Margaret MacGibeny, MD, PhD, Jay-Hyun Jo, PhD, and Heidi Kong, MD, MHSc, Cutaneous Microbiome and Inflammation Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, stated that while there's been an overall decrease in antibiotic prescribing within the last decade, US dermatologists continue to prescribe these treatments at higher rates than clinicians in other specialties.

"Dermatologists are critical stakeholders in antibiotic stewardship efforts and play essential roles in optimizing antibiotic use," they wrote.

The Research

The authors referenced a cross-sectional analysis of prescribing trends among US dermatologists from 2008 to 2016 that revealed tetracyclines as the most frequently prescribed antibiotics. Cephalexin and trimethoprim-sulfamethoxazole (TMP-SMX) were also reported as commonly prescribed.

Inflammatory skin diseases such as acne and rosacea were associated with extended antibiotic regimens (more than 28 days), while regimens for infections and surgical visits which were associated with short antibiotic courses (median 7-14 days).

Prescribing for extended use for acne and rosacea has decreased in recent years according to analyses, but authors mentioned a concerning increase in short-term courses following surgical visits. Ultimately, the need for further antibiotic optimization is supported by these data.

Furthermore, antibiotics have the ability to alter skin microbial communities, which has been demonstrated in studies that revealed a shift in composition and diversity of the human skin microbiome following systemic antibiotics.

Further Investigation for Antibiotic Stewardship

Significant changes in patients were observed in those who received doxycycline or TMP-SMX when compared with those who did not, according to an analysis. Since skin is an environment that welcomes microbes of all kinds, it can also be associated with emergent drug-resistant microbes.

For this reason, authors argued that it's critical for dermatologists to incorporate principles of antibiotic stewardship into prescribing practices. The CDC has even emphasized a focus on potential alternative treatment options for high-priority conditions.

The aim to eliminate unnecessary antibiotic use is important for the potential limitations of nonantibiotic therapies. Authors noted guidelines for nonantibiotic therapies that are currently limited due to paucity of prospective randomized clinical trials comparing the effectiveness of systemic antibiotics compared with alternative treatments for dermatologic conditions.

"In summary, the optimal approach to antibiotic prescribing in dermatology involves a risk-benefit analysis," authors wrote. "To achieve the most effective outcomes, dermatologists should consider all therapeutic options. By incorporating antibiotic stewardship principles into prescribing practices, dermatologists can optimize appropriate antibiotic use while limiting the development and spread of antimicrobial resistance and minimizing antibiotic-associated complications."

The article "Antibiotic Stewardship in Dermatology—Reducing the Risk of Prolonged Antimicrobial Resistance in Skin" was published in JAMA Dermatology.