Analyzing antibiotic prescribing practices in the treatment of hidradenitis suppurativa

Summary: The purpose of this study is to assess the duration of oral antibiotic treatment in different stages of Hidradenitis Suppurativa (HS). Antibiotics are a mainstay for the treatment of HS with current guidelines recommending 1-12 months of antibiotics. With higher rates of antibiotic resistance in HS, it is essential to assess antibiotic prescribing practices. A retrospective chart review analyzed patients with HS at a single institution from April 2023 to July 2024. Demographic factors and stages of HS disease were analyzed. The duration of antibiotic treatment was analyzed with a linear regression model to assess for differences in duration with various stages of HS. Additionally, disease severity was compared using a multinomial regression model assessing the impact of race, gender, and age. Among 111 patients with HS, 84% were female and 76% were African American, with a mean age of 47.4 years. Hurley staging was used to stratify disease severity with 27% Stage I disease, 19% Stage II disease, and 28% Stage III disease. While age and race had no impact on disease severity, males were found to have a 7.0 times higher chance of having Stage III disease than Stage I disease (p <.03). Oral antibiotics were prescribed to 77.5% of patients with a mean duration of treatment of 15.0 months (standard deviation: 25.0 months). The most commonly prescribed antibiotic was doxycycline (76%), followed by clindamycin/rifampin (19%). There was no significant difference in antibiotic duration across the three stages of disease. The findings of this study indicate that the duration of oral antibiotic prescriptions in HS needs to be re-assessed. The mean duration of treatment is 3 months over recommended guidelines, with no escalation in the duration of antibiotic treatment as the disease progresses. In the future, providers need to be cognizant of their prescribing practices to reduce the risks of antibiotic resistance and improve antibiotic stewardship in HS. Vyshnavi Rallapalle¹, Mallory A. Von Lotten¹, Madeleine Obuya¹, Evan Liu¹, Tiffany Mayo² 1. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States. 2. Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, United States. Clinical Research: Epidemiology and Observational Research