title: The use of oral antibiotics before isotretinoin therapy in patients with acne.
abstract: BACKGROUND
  Systemic antibiotics are used widely to treat moderate to severe acne, but increasing antibiotic resistance makes appropriate use a priority.
  
  
  OBJECTIVE
  We sought to determine the duration of systemic antibiotic use in patients with inflammatory/nodulocystic acne who eventually required isotretinoin.
  
  
  METHODS
  We performed a retrospective, single-site chart review of patients with acne diagnostic codes evaluated January 1, 2005 to December 31, 2014, at a dermatology practice in an academic medical center. Included patients were prescribed isotretinoin during the study period and received 30 days or more of antibiotics.
  
  
  RESULTS
  The average duration of antibiotic use was 331.3 days. In all, 21 patients (15.3%) were prescribed antibiotics for 3 months or less, 88 patients (64.2%) for 6 months or more, and 46 patients (33.6%) for 1 year or longer. Patients treated only at the study site had a mean duration of antibiotic treatment of 283.1 days whereas patients who also received antibiotics from another institution had a mean duration of 380.2 days. This difference approached statistical significance (P = .054).
  
  
  CONCLUSIONS
  This study was limited to a single center.
  
  
  CONCLUSIONS
  Expert guidelines recommend responsible use of antibiotics in acne in light of emerging resistance. We found that patients who eventually received isotretinoin had extended exposure to antibiotics, exceeding recommendations. Early recognition of antibiotic failure and the need for isotretinoin can curtail antibiotic use.
authors.affiliation: Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
authors.forename: Arielle R
authors.initials: AR
authors.lastname: Nagler
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Milam
authors.affiliation: Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address: seth.orlow@nyumc.org.
authors.forename: Seth J
authors.initials: SJ
authors.lastname: Orlow
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy*; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015474:Isotretinoin / Q000627:therapeutic use*; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D003879:Dermatologic Agents; D015474:Isotretinoin
keywords: acne; antimicrobial resistance; isotretinoin; systemic antibiotics