Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Department of Dermatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
Br J Dermatol. 2023 Feb 22;188(3):361-371. doi: 10.1093/bjd/ljac084.
The inappropriate use of antibiotics is understood to contribute to antimicrobial resistance. Oral antibiotics are regularly used to treat moderate-to-severe acne vulgaris. In practice, we do not know the typical length of oral antibiotic treatment courses for acne in routine primary care and what proportion of people receive more than one course of treatment following a new acne diagnosis.
To describe how oral antibiotics are prescribed for acne over time in UK primary care.
We conducted a descriptive longitudinal drug utilization study using routinely collected primary care data from the Clinical Practice Research Datalink GOLD (2004-2019). We included individuals (8-50 years) with a new acne diagnosis recorded between 1 January 2004 and 31 July 2019.
We identified 217 410 people with a new acne diagnosis. The median age was 17 years [interquartile range (IQR) 15-25] and median follow-up was 4.3 years (IQR 1.9-7.6). Among people with a new acne diagnosis, 96 703 (44.5%) received 248 560 prescriptions for long-term oral antibiotics during a median follow-up of 5.3 years (IQR 2.8-8.5). The median number of continuous courses of antibiotic therapy (≥ 28 days) per person was four (IQR 2-6). The majority (n = 59 010, 61.0%) of first oral antibiotic prescriptions in those with a recorded acne diagnosis were between the ages of 12 and 18. Most (n = 71 544, 74.0%) first courses for oral antibiotics were for between 28 and 90 days. The median duration of the first course of treatment was 56 days (IQR 50-93 days) and 18 127 (18.7%) of prescriptions of ≥ 28 days were for < 6 weeks. Among people who received a first course of oral antibiotic for ≥ 28 days, 56 261 (58.2%) received a second course after a treatment gap of ≥ 28 days. The median time between first and second courses was 135 days (IQR 67-302). The cumulative duration of exposure to oral antibiotics during follow-up was 255 days (8.5 months).
Further work is needed to understand the consequences of using antibiotics for shorter periods than recommended. Suboptimal treatment duration may result in reduced clinical effectiveness or repeated exposures, potentially contributing to antimicrobial resistance.
不合理使用抗生素被认为是导致抗菌药物耐药性的原因之一。口服抗生素常被用于治疗中重度寻常痤疮。实际上，我们并不清楚在常规初级保健中治疗痤疮的口服抗生素疗程的典型长度，也不知道在新诊断为痤疮后，有多少人接受了不止一个疗程的治疗。
描述在英国初级保健中，口服抗生素治疗痤疮的时间变化情况。
我们使用临床实践研究数据链 GOLD（2004-2019 年）中的常规收集的初级保健数据开展了一项描述性纵向药物利用研究。我们纳入了在 2004 年 1 月 1 日至 2019 年 7 月 31 日期间有新诊断为痤疮的患者（8-50 岁）。
我们确定了 217410 例新诊断为痤疮的患者。患者的中位年龄为 17 岁[四分位距（IQR）15-25]，中位随访时间为 4.3 年（IQR 1.9-7.6）。在新诊断为痤疮的患者中，96703 人（44.5%）在中位随访 5.3 年（IQR 2.8-8.5）期间接受了 248560 剂长期口服抗生素治疗。每位患者接受连续疗程（≥28 天）的抗生素治疗的中位数为 4 个疗程（IQR 2-6）。大多数（n=59010，61.0%）首次接受口服抗生素治疗的患者年龄在 12-18 岁之间。大多数（n=71544，74.0%）首次口服抗生素疗程为 28-90 天。首次疗程的中位持续时间为 56 天（IQR 50-93 天），18127 份（18.7%）≥28 天的处方治疗时间<6 周。在接受≥28 天疗程的口服抗生素治疗的患者中，56261 人（58.2%）在≥28 天的治疗间隙后接受了第二个疗程。第一次和第二次疗程之间的中位时间为 135 天（IQR 67-302）。在随访期间，口服抗生素的累积暴露时间为 255 天（8.5 个月）。
需要进一步研究以了解使用抗生素治疗时间短于推荐时间的后果。治疗时间不足可能会降低临床疗效或导致重复暴露，从而可能导致抗菌药物耐药性。
