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Treating severe acne hampered by 'antibiotic overuse'

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Clinicians treating severe acne leave too many patients on ineffective antibiotics for far too long before prescribing more potent needed therapy with isotretinoin, claim US researchers.

The researcher’s analysis involved a detailed review of 137 medical histories of patients, all over the age of 12 and treated for severe cases of the skin condition from 2005-14.

“We need to find a better balance between trying antibiotics that may work and getting isotretinoin quickly to patients”

Arielle Nagler

They said the study was the first to focus specifically on the history of antibiotic overuse in severe cases of acne, which were all eventually treated with isotretinoin.

The case reviews involved showed that on average, those with severe, often “cystic” acne were kept on initial antibiotic therapy for 11 months before it was recognised that the drugs were not working, and they were switched to isotretinoin therapy.

Beyond the fact that the antibiotics were not working, the researchers warned that the overuse added to the perils of antibiotic resistance.

They also found that among the 137 patients with severe acne in their study who eventually received isotretinoin – commonly prescribed as a daily pill – there was a lag of nearly six months on average from the time it was first mentioned by their clinician until patients began taking it.

The study findings are published in the Journal of the American Academy of Dermatology.

“Our study suggests that physicians need to recognise within weeks, not months, when patients are failing to respond to antibiotic therapy in cases of severe acne,” said senior study author Professor Seth Orlow, from New York University’s Langone Medical Center.

Therapeutic strategies for acne vulgaris

According to Professor Orlow, antibiotic therapy could be very effective for inflammatory types of acne and switching to different antibiotics was routine practice when another antibiotic has failed to reduce symptoms.

However, he said clinical guidelines recommended limiting such antibiotic therapy to two months to three months each, or six months overall, unless significant improvements are seen.

Although there were multiple causes for the delays, the authors noted that some were due to the tight controls placed on the drug because of the increased risk it poses for birth defects, and concerns about depression and other potentially serious side effects.

Lead study author Dr Arielle Nagler said fears about isotretinoin side effects helped contribute to prolonged antibiotic overuse and delayed access to the drug.

She said: “We need to find a better balance between trying antibiotics that may work and getting isotretinoin quickly to patients for whom antibiotics are not working.”

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Readers' comments (1)

  • antibiotics were prescribed in my case as a let's see if they work whilst you wait to be seen by the dermatologist, who then put me on isotretinoin straight away. For this I am forever grateful, and it is the reason I only have a couple of patches of facial scars and am not covered in them. For all it's side effects isotretinoin is a miracle drug, the push against it makes me sad, especially when it comes from those who have had first hand experience of needing it.

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