Antibiotic stewardship in dermatology: An analysis of acne vulgaris prescribing practices

Summary: Abstract Body: The purpose of this study is to assess oral antibiotic prescribing trends for acne vulgaris within a dermatology clinic. Guidelines recommend limiting oral antibiotic use to 3–4 months in combination with benzoyl peroxide or topical retinoids to minimize antibiotic resistance. However, discrepancies between guidelines and actual prescribing habits remain a concern. A retrospective chart review analyzed data for patients diagnosed with acne vulgaris from April 2023 to June 2024. Data points included demographics, prescriptions for topical and oral antibiotics, benzoyl peroxide, topical combination therapies, oral isotretinoin, oral contraceptives, spironolactone, and topical dapsone. The primary outcomes analyzed were antibiotic type prescribed and duration of antibiotic prescription to evaluate adherence to current guidelines. Among 168 patients with acne vulgaris, 128 were female and 40 male, with a mean age of 27.24 years (median: 27, range: 11–71). Benzoyl peroxide was used by 55.5% of patients, while 68% were prescribed topical retinoids, and 70% received topical antibiotics. Oral antibiotics were prescribed to 35.1% of patients, with doxycycline being the most common prescribed at 97%, followed by minocycline and sarecycline. The mean duration of oral antibiotic therapy was 7.08 months (median: 5, range: 0.5–36 months). After antibiotic therapy, 28% of patients transitioned to isotretinoin and 24% to spironolactone. The findings of this study highlight the need to re-evaluate prescribing practices for oral antibiotics in the management of acne vulgaris. The mean duration of antibiotic therapy at 7 months exceeds the guideline-recommended duration of 3–4 months, underscoring the importance of aligning practices with stewardship principles. To mitigate the risks of prolonged antibiotic use, future efforts should focus on provider education and the integration of updated guidelines into clinical practice to promote more judicious use of oral antibiotics. Mallory A. Von Lotten¹, Vyshnavi Rallapalle¹, Madeleine Obuya¹, Tiffany Mayo² 1. The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States. 2. Dermatology, The University of Alabama at Birmingham, Birmingham, AL, United States. Clinical Research: Epidemiology and Observational Research