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Original Investigation
January 16, 2019

Trends in Oral Antibiotic Prescription in Dermatology, 2008 to 2016

Author Affiliations
  • 1Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 2Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 3Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 4United States Public Health Service Commissioned Corps, Rockville, Maryland
  • 5Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
JAMA Dermatol. 2019;155(3):290-297. doi:10.1001/jamadermatol.2018.4944
Key Points

Question  In what settings do dermatologists most frequently prescribe antibiotics, and how is this use changing over time?

Findings  Between 2008 and 2016 among 985 866 courses of oral antibiotics prescribed by 11 986 unique dermatologists in this repeated cross-sectional analysis, there was a decrease in overall antibiotic prescribing from 3.36 to 2.13 courses per 100 visits. However, there was an increase in prescribing associated with surgical visits from 3.92 to 6.65 courses per 100 visits.

Meaning  Overall antibiotic use by dermatologists is declining; however, the use of oral antibiotics after surgical visits is increasing, and the value of this practice should be carefully evaluated.

Abstract

Importance  Dermatologists prescribe more oral antibiotic courses per clinician than any other specialty, and this use puts patients at risk of antibiotic-resistant infections and antibiotic-associated adverse events.

Objective  To characterize the temporal trends in the diagnoses most commonly associated with oral antibiotic prescription by dermatologists, as well as the duration of this use.

Design, Setting, and Participants  Repeated cross-sectional analysis of antibiotic prescribing by dermatologists from January 1, 2008, to December 31, 2016. The setting was Optum Clinformatics Data Mart (Eden Prairie, Minnesota) deidentified commercial claims data. Participants were dermatology clinicians identified by their National Uniform Claim Committee taxonomy codes, and courses of oral antibiotics prescribed by these clinicians were identified by their National Drug Codes.

Exposures  Claims for oral antibiotic prescriptions were consolidated into courses of therapy and associated with the primary diagnosis from the most recent visit. Courses were stratified into those of extended duration (>28 days) and those of short duration (≤28 days).

Main Outcomes and Measures  Frequency of antibiotic prescribing and associated diagnoses. Poisson regression models were used to assess for changes in the frequency of antibiotic prescribing over time.

Results  Between 2008 and 2016 among 985 866 courses of oral antibiotics prescribed by 11 986 unique dermatologists, overall antibiotic prescribing among dermatologists decreased 36.6% (1.23 courses per 100 visits) from 3.36 (95% CI, 3.34-3.38) to 2.13 (95% CI, 2.12-2.14) courses per 100 visits with a dermatologist (prevalence rate ratio for annual change, 0.931; 95% CI, 0.930-0.932), with much of this decrease occurring among extended courses for acne and rosacea. Oral antibiotic use associated with surgical visits increased 69.6% (2.73 courses per 100 visits) from 3.92 (95% CI, 3.83-4.01) to 6.65 (95% CI, 6.57-6.74) courses per 100 visits associated with a surgical visit (prevalence rate ratio, 1.061; 95% CI, 1.059-1.063).

Conclusions and Relevance  Continuing to develop alternatives to oral antibiotics for noninfectious conditions, such as acne, can improve antibiotic stewardship and decrease complications from antibiotic use. In addition, the rising use of postoperative antibiotics after surgical visits is concerning and may put patients at unnecessary risk of adverse events. Future studies are needed to identify the value of this practice and the risk of adverse events.

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