AAD
  • Registration
  • Daily Coverage
  • Industry Highlights
  • Product Samples
  • Small Exhibit Spotlight
  • Program
Topics
  • Daily Coverage
  • Industry Highlights
  • Product Samples
  • Small Exhibit Spotlight
  • Program
Resources
  • Registration
Facebook iconInstagram iconTwitter icon
Mar 20, 2023

Dermatologists top the list in antibiotic prescriptions

Sulzberger Memorial Lecture encourages a more consequential approach.


David J. Margolis, MD, PhD, FAAD
David J. Margolis, MD, PhD, FAAD

Dermatologists know that overprescribing antibiotics is a problem. What some may not know is that on an individual basis, dermatologists prescribe more antibiotics than any other practitioners in any other specialty.

“There are fewer dermatologists than many other types of physicians, and efforts focusing on limiting antibiotic use have tended to focus on numerically larger groups such as primary care, emergency providers, and pediatricians,” said David J. Margolis, MD, PhD, FAAD, Gerald R. Lazarus professor of dermatology and senior scholar at the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania Perelman School of Medicine in Philadelphia. “Other groups are larger, and from a public health point of view are crucial for decreasing unneeded antibiotic use. But dermatologists — we are the number one prescribers.”

Is it good for the long haul?

Dr. Margolis discussed the latest findings on antibiotic use and overuse in dermatology during Sunday’s “P151 – Plenary” Marion B. Sulzberger, MD, Memorial Award and Lectureship, “Pharmacotherapy: Antibiotic Use in Dermatology.” Dermatologists should not stop prescribing antibiotics when appropriate, he said, but they should consider the necessity of their use, the potential clinical consequences of long-term antibiotic use, and the potential for switching to other, non-antibiotic agents.

“Dermatologists frequently use agents like doxycycline and minocycline, not just for their antimicrobial properties but also as anti-inflammatories,” Dr. Margolis explained. “And where most clinicians prescribe antibiotics for three to 14 days, depending on the organism and the seriousness of the infection, dermatologists often prescribe medications like doxycycline for acne for months and sometimes for years.”

On the population level, long-term use of antibiotics raises concerns about resistance and the rise of what the popular press likes to call “super bugs,” he said. Hospitals, health systems, and academic centers have devoted significant resources to antibiotic stewardship to slow local development of resistance by limiting the use of antibiotics.

Brewing side effects

There are also concerns at the patient level about potential side effects of long-term antibiotic use, including an increased risk for certain types of cancer, lupus and other immunomodulated diseases, diarrhea, nausea, and more. Antibiotics can also give rise to severe cutaneous adverse events like DRESS (drug reaction with eosinophilia and systemic symptoms), resulting in hepatitis, nephritis, interstitial pneumonia, myocarditis, and other potentially life-threatening hypersensitivity reactions.

Other options available

There is at least one potential alternative to antibiotic treatment for acne in women — spironolactone. Originally developed as a diuretic, spironolactone modulates androgen production to reduce sebum overproduction, which can improve the clinical manifestations of acne.

“Spironolactone isn’t a very good diuretic, but its anti-androgen side effects can be quite effective in treating women who develop acne,” Dr. Margolis said. “It has become increasingly popular, although there aren’t many clinical trials that demonstrate how well spironolactone works or how effective it might be compared to antibiotics.”

Dr. Margolis is co-principal investigator on a head-to-head comparison of spironolactone 100 mg/day versus doxycycline 100 mg/day, the most common regimen for both agents. The trial launched in March 2022 and should be complete the summer of 2026.

“The goal today is to help dermatologists be more thoughtful about antibiotic use,” he said. “It’s not a matter of what dermatologists should or shouldn’t do, it’s about being thoughtful and considering the potential consequences of prescribing antibiotics as well as alternatives.”

Visit AAD DermWorld Meeting News Central for more articles.

Interesting Stories
Advancing Therapeutic Conversations
Presented by AbbVie
Advancing Therapeutic Conversations
Janssen-Sponsored Symposium
Presented by Janssen Biotech, Inc.
Janssen-Sponsored Symposium
Prurigo Nodularis and Atopic Dermatitis:
Presented by Sanofi and Regeneron Pharmaceuticals, Inc.
Prurigo Nodularis and Atopic Dermatitis:
Join Us to Learn More About SOTYKTU<sup>TM</sup> (deucravacitinib):
Presented by Bristol Myers Squibb
Join Us to Learn More About SOTYKTUTM (deucravacitinib):
Beyond the Scalp: Deciphering the Complexities of Alopecia Areata...
Presented by Pfizer Inc.
Beyond the Scalp: Deciphering the Complexities of Alopecia Areata...
Residents and Young Physicians: Your Guide to the AAD Annual Meeting
Presented by Neutrogena
Residents and Young Physicians: Your Guide to the AAD Annual Meeting
What makes a biosimilar and an Interchangeable biosimilar different?
Presented by Boehringer Ingelheim
What makes a biosimilar and an Interchangeable biosimilar different?
More in AAD 2023 Annual Meeting
Safi Bahcall
AAD 2023 Annual Meeting
Nurture the unexpected
Mar 20, 2023
Richard L. Gallo, MD, PhD, FAAD
AAD 2023 Annual Meeting
New approach uses microbiome to treat skin disease
Mar 20, 2023
Camp Discovery 92
AAD 2023 Annual Meeting
Refer a patient to Camp Discovery!
Mar 20, 2023
Amy J. McMichael, MD, FAAD
AAD 2023 Annual Meeting
A question of belonging
Mar 20, 2023
22 698 Ia23 Web Card 3x2
AAD 2023 Annual Meeting
Mark your calendar for Innovation Academy 2023
Join the learning
Mar 20, 2023
Getty Images 479036574
AAD 2023 Annual Meeting
Save the date for the 2024 Annual Meeting
Mark you calendar for AM2024
Mar 20, 2023
2022 03 21 12 20 34 6238b40dd1e28
AAD 2023 Annual Meeting
Access your Certificate of Attendance
Download online
Mar 20, 2023
2022 03 21 12 26 25 6238b55bf2d38
AAD 2023 Annual Meeting
Claim CME
Claim CME
Mar 20, 2023
Aad March20
AAD 2023 Annual Meeting
Session highlights for Monday
Mar 20, 2023
Jane Margaret Grant-Kels, MD, FAAD
AAD 2023 Annual Meeting
Ethical dilemmas hiding in plain sight
Mar 20, 2023
John T. Schiller, PhD
AAD 2023 Annual Meeting
Taking on cervical cancer, one shot at a time
Mar 20, 2023
Cause Marketing
AAD 2023 Annual Meeting
Support your patients, win prizes!
Mar 19, 2023
AAD
Facebook iconInstagram iconTwitter icon
© Ascend Media All rights reserved. DermWorld Meeting News Central is a publication of the American Academy of Dermatology.