Breaking News
January 16, 2019 - A new brain imaging study challenges the dominant theoretical model of autism spectrum disorders
January 16, 2019 - GoFundMe CEO: ‘Gigantic Gaps’ In Health System Showing Up In Crowdfunding
January 16, 2019 - Induced neuronal cells derived from fibroblasts are similar to neurons in the brain
January 16, 2019 - New study finds link between childhood abuse and suicide in later life
January 16, 2019 - Lifestyle and health factors that are good for the heart can also prevent diabetes
January 16, 2019 - Scientists take another step in understanding bacteria that cause Salmonella epidemic
January 16, 2019 - Look to Your Aunts, Uncles and Parents for Clues to Your Longevity
January 16, 2019 - Study finds ADHD drugs are unlikely to cause cardiac damage in children who take them
January 16, 2019 - Call The Midwife! (If The Doctor Doesn’t Object)
January 16, 2019 - Changes in hippocampal structural connectivity differentiate responders of electroconvulsive therapy
January 16, 2019 - Study sheds light on the deadly venom of Mojave rattlesnakes
January 16, 2019 - University of Nebraska to develop new drugs that prevent and counteract effects of radiation exposure
January 16, 2019 - Sugar-based stent makes precarious sewing process easier
January 16, 2019 - FDA-approved drug hampers cancer metastasis in animal model, shows study
January 16, 2019 - Childhood body composition may play a role in future respiratory health
January 16, 2019 - Outdated commissioning methods are failing mental health services in the UK, reveals report
January 16, 2019 - Unconventional immune cells trigger disturbed cytokine production in human spondyloarthritis
January 16, 2019 - Patients Turn To GoFundMe When Money And Hope Run Out
January 16, 2019 - Researchers develop novel viral identification method
January 16, 2019 - Study proposes improvements in pharmacological study of cognitive function enhancers in schizophrenia
January 16, 2019 - Study points to potential new biomarker and drug target for amyotrophic lateral sclerosis
January 16, 2019 - Differences in geographic origin of genes may affect mitochondrial function
January 16, 2019 - Study analyzes vaccine-preventable infections in children who receive solid organ transplants
January 16, 2019 - MiRagen Announces New Clinical Data in Patients With Three Different Types of Blood Cancers Treated With Cobomarsen
January 16, 2019 - Scientists uncover why knee joint injury leads to osteoarthritis
January 16, 2019 - Salk team uses new model to study health effects of AMP-activated protein kinase
January 16, 2019 - Research reveals novel approach to suppressing chemotherapy-induced tumor growth
January 16, 2019 - Researchers reveal how fasting leads to better overall health
January 16, 2019 - Deprivation and neglect in early childhood have impact on cognitive functioning in adolescence, shows study
January 16, 2019 - Training Students to use Imaging Techniques: NMR and EPR
January 16, 2019 - Nerve transfer surgery restores arm movement in children with acute flaccid myelitis
January 16, 2019 - Exelixis Announces U.S. FDA Approval of Cabometyx (cabozantinib) Tablets for Previously Treated Hepatocellular Carcinoma
January 16, 2019 - DNA vaccine reduces both toxic proteins linked to Alzheimer’s
January 16, 2019 - Even in the U.S., poor women often can't afford tampons, pads
January 16, 2019 - One time use of Marijuana could affect teen brains finds study
January 16, 2019 - Persistent Opioid Use High in Head, Neck Cancer Patients
January 16, 2019 - Questions to ask your doctor about post pregnancy care: MedlinePlus Medical Encyclopedia
January 16, 2019 - Neurons with good housekeeping are protected from Alzheimer’s
January 16, 2019 - Is mindfulness worthy of all the hype?
January 16, 2019 - Physical Activity, Any Type or Amount, Cuts Health Risk from Sitting
January 16, 2019 - New understanding in the evolution of human feet
January 15, 2019 - AHA: New Cholesterol Guidelines Put Ethnicity in the Spotlight
January 15, 2019 - Different brain areas linked to smoking and drinking
January 15, 2019 - Henry Marsh shares insights into neurosurgery and more at Dean’s Lecture Series
January 15, 2019 - Want to Live Longer? For Just 30 Minutes a Day, Do Anything Else But Sit
January 15, 2019 - The Current issue of “The view from here” is concerned with Targets
January 15, 2019 - Plain packaging sparked tobacco price rises, new study finds
January 15, 2019 - Sedentary lifestyles can be unhealthy, physical activity can lower risk
January 15, 2019 - Gut microbiome may help prevent development of cow’s milk allergy
January 15, 2019 - Lesbian, gay and bisexual individuals more likely to suffer severe substance use disorders
January 15, 2019 - New England Journal of Medicine Publishes Positive Results of the Pivotal Trial of Cablivi (caplacizumab) for Rare Blood Clotting Disorder
January 15, 2019 - Levels of inflammatory marker (CRP) linked to housing type and tenure
January 15, 2019 - Three gifts I’m glad I gave myself in 2018
January 15, 2019 - Columbia’s Pediatrics Department Names New Vice Chairs, Expands Leadership
January 15, 2019 - US FDA Accepts Regulatory Submissions for Review of Tafamidis to Treat Transthyretin Amyloid Cardiomyopathy
January 15, 2019 - Staying fit can cut your risk of heart attack by half
January 15, 2019 - Vitamin D supplements are of no gain to those over 70, study shows
January 15, 2019 - Scientists create comprehensive new method to predict breast cancer risk
January 15, 2019 - Research shows connection between social media use and impaired risky decision-making
January 15, 2019 - FDA Approves Expanded Use of Adacel (Tdap) Vaccine for Repeat Vaccination
January 15, 2019 - Treating spinal pain with replacement discs made of ‘engineered living tissue’ moves closer to reality
January 15, 2019 - Providers Walk ‘Fine Line’ Between Informing And Scaring Immigrant Patients
January 15, 2019 - Outcomes Poorer for Medicaid Beneficiaries With STEMI
January 15, 2019 - Decorative Products on Foods Can Be Unsafe
January 15, 2019 - A dream of sustainable surgery in Uganda
January 15, 2019 - Study shows how herpes viruses and tumors have learned to manipulate the same ancient RNA
January 15, 2019 - Common Heart, Diabetes Meds May Help Ease Mental Illness
January 15, 2019 - Stress and trauma in earliest years linked to reduced hippocampal volume in adolescence
January 15, 2019 - Scientists identify endogenous activator of sigma-1 receptors in human cells
January 15, 2019 - MAR treatments unlikely to be cause of premature or low birth weight babies
January 15, 2019 - Parental CPTSD increases transmission of trauma to offspring of Tutsi genocide survivors
January 15, 2019 - High-fat diets shown to increase blood pressure
January 15, 2019 - New institute for food safety to be established in Netherlands
January 15, 2019 - Keele University researchers receive £2.4 million grant to help reduce overprescribing of opioids
January 15, 2019 - Synthetic compound reverses mutant p53 aggregate accumulation, study shows
January 15, 2019 - First elder care robot tested in a WSU smart home apartment
January 15, 2019 - Oxford researchers explore relationship between technology use and adolescent mental health
January 15, 2019 - From microbiome research to healthier and sustainable foods
January 15, 2019 - How coaching moms and dads improves infants’ language skills
January 15, 2019 - Precision health approach tapped to identify causes of poverty
Oral Antibiotic Rx Remain High

Oral Antibiotic Rx Remain High

image_pdfDownload PDFimage_print

Despite recommendations to limit the use of oral antibiotics, dermatologists continue to prescribe them in high numbers, according to a large, retrospective analysis of U.S. prescribing trends from 2004 to 2013.

However, spironolactone prescriptions increased nearly fourfold over that same time period, which is a good sign that alternatives may be gaining traction, the researchers said, writing in the Journal of the American Academy of Dermatology.

“Given concerns about antibiotic resistance and other complications associated with oral antibiotic use, it is encouraging to observe an increase in the use of alternative agents such as spironolactone for the treatment of acne in female patients,” said John S. Barbieri, MD, MBA, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, and colleagues.

The number of spironolactone prescriptions marched steadily upward over time in the analysis, which was based on review of claims data representing 12 million to 14 million annual covered lives.

Dermatologists prescribed 2.08 courses of spironolactone per 100 acne patients in 2004, increased to 4.10 courses per 100 patients in 2010 and 8.13 courses in 2013.

However, oral antibiotic usage remained much higher over the entire study period, the results showed. Dermatologists prescribed 26.24 courses of antibiotics per 100 acne patients in 2004. That number appeared to dip slightly to 22.90 courses per 100 patients in 2010, but returned to 27.08 courses in 2013.

“Whereas we initially observed a slight decrease in oral antibiotic use, this trend has reversed in recent years,” the researchers said.

It is uncertain why oral antibiotic use seemed to decrease but then increase again, although the team noted that the shift upward followed the “dramatic decrease” in use of drospirenone-containing combined oral contraceptive pills starting in 2009: “It is possible that because of concerns about the safety of drospirenone-containing combined oral contraceptive pills, clinicians shifted their prescribing behavior toward the use of more oral antibiotics.”

Use of combined oral contraceptive pills dominated the group of systemic oral agents in this claims dataset, from 34.31 courses per 100 acne patients in 2004, which declined somewhat to approximately 30 courses per 100 patients in 2010 and 2013.

The analysis included a total of 594,776 courses of oral antibiotic treatment, 527,288 courses of combined oral contraceptives, 61,042 courses of spironolactone, and 108,664 courses of isotretinoin. The study also includes prescribing data for non-dermatologists.

The authors suggested that dermatologists identify patients who might benefit most from alternatives to oral antibiotics, including spironolactone, isotretinoin, and oral contraceptives.

Oral antibiotics are among the most commonly prescribed treatments for acne that cannot be managed with topical therapies, the researchers noted. In fact, dermatologists are the highest prescribers per capita of antibiotics compared with any other medical specialty.

Excessive use of antibiotics persists throughout medicine despite ongoing concerns about excessive use of antibiotics due to emerging antibiotic resistance, as well as adverse effects that include pharyngitis and inflammatory bowel disease, Barbieri et al wrote.

Guidelines from the American Academy of Dermatology (AAD) and others recommend that the oral antibiotic treatment duration be limited to 3 to 6 months, although a subset of patients may require longer treatment.

The duration of oral antibiotic therapy in the analysis by Barbieri and colleagues was indeed a median of 126 days for patients receiving care from dermatologists, and 129 days for those treated by non-dermatologists. However, the sheer numbers of prescriptions were a cause of concern, with the authors calling for “judicious use” and “stewardship” of antibiotics.

“Like the authors of prior studies, we observe that prescribing behavior for oral antibiotics and the use of concomitant topical retinoids are not well aligned with current guidelines, although additional research is needed to understand the optimal duration of therapy with oral antibiotics.”

Despite concerns over current levels of antibiotic use, Barbieri et al said they were hopeful that use of antibiotic alternatives will “continue to grow,” particularly following recent data suggesting that routine potassium monitoring may be unnecessary for healthy women taking spironolactone for acne.

“Increasing the use of concomitant topical retinoids, and additional work to identify those patients who would benefit most from alternative agents such as spironolactone, combined oral contraceptive pills, or isotretinoin represent potential opportunities to improve the care of patients with acne,” the team concluded.

This article originally appeared on the website of our partner, Dermatology Times, which is part of UBM Medica. (Free registration is required.)

2018-01-29T10:30:00-0500

Tagged with:

About author

Related Articles