Clinicians who treat severe acne leave too many patients on ineffective antibiotics for too long before prescribing a stronger therapy with the medication isotretinoin, an analysis conducted by researchers at NYU Langone Medical Center concluded. Findings from the study are published in the Journal of the American Academy of Dermatology.

This was the first study to focus on the history of antibiotic overuse in severe acne, which were eventually all treated with isotretinoin.  “Physicians need to recognize within weeks, not months, when patients are failing to respond to antibiotic therapy in cases of severe acne,” stated Seth Orlow, MD, PhD, the study’s senior investigator. Dr. Orlow and colleagues reviewed 137 medical histories of patients aged >12 who were treated at NYU Langone for severe cases of the skin condition between 2005–2014. 

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The case reviews showed that patients with severe (often cystic) acne were kept on initial antibiotic treatment for 11 months before realizing they were ineffective, and before switching patients to isotretinoin therapy. In addition to the lack of efficacy, the antibiotic overuse adds to the growing concerns of resistance. 

Study authors also found that of the 137 study patients with severe acne who eventually were prescribed isotretinoin, there was a delay of almost 6 months on average from the time of first mention by their clinician until patients began taking it. Some reasons were due to the restrictions placed on the drug for its risk of birth defects, depression, and other potentially serious adverse events. Also, concerns about isotretinoin side effects and federal restrictions all have contributed to prolonged antibiotic overuse and a lag in access to the drug, researchers added. 

Arielle Nagler, MD, lead study author, concluded that there needs to be a better balance between trying antibiotic therapy that may work and supplying isotretinoin quickly to patients for whom antibiotics are ineffective. Clinicians should also start discussing with patients sooner about possible isotretinoin therapy so that they may be more open to the drug and any concerns would have already begun to be addressed. 

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