In Reply We appreciate the interest of Smith and colleagues in our recent article regarding antibiotic use associated with dermatologic procedures.1,2 We agree that there are likely many potential approaches to optimize antibiotic use associated with dermatologic procedures such as Mohs surgery, which is highlighted by the substantial geographic variation observed in our study. As Smith and colleagues discuss, clinical monitoring without use of prophylactic oral antibiotics may be a reasonable strategy for many patients undergoing Mohs surgery or other dermatologic procedures. There are also likely opportunities to decrease the duration of use of prophylactic oral antibiotics when they are prescribed.3,4 In addition, strategies to reduce the baseline risk of infection, such as the decolonization strategy proposed by Smith and colleagues, may represent an exciting opportunity to reduce the need for prophylactic antibiotics, and we applaud their efforts to study this important topic with a randomized trial.5
Barbieri JS, Etzkorn JR, Margolis DJ. Preoperative Topical Decolonization—An Additional Strategy to Reduce Oral Antibiotic Prophylaxis for Mohs Infections?—Reply. JAMA Dermatol. 2019;155(9):1089–1090. doi:10.1001/jamadermatol.2019.1890
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