title: The extinction of topical erythromycin therapy for acne vulgaris and concern for the future of topical clindamycin.
abstract: OBJECTIVE
  This study aims to evaluate changes in topical antibiotic prescribing trends for acne.
  
  
  METHODS
  We retrospectively reviewed the National Ambulatory Medical Care Survey data from 1993 to 2012 for all visits in which acne vulgaris was the primary diagnosis.
  
  
  RESULTS
  Acne vulgaris represented an estimated 94.5 million (92.3, 96.8) visits during the 20-year study period. Bivariate analysis showed that over time erythromycin use declined (p < 0.001) and clindamycin use rose (p = 0.10). Multivariate analysis showed that the likelihood of erythromycin use declined to near zero (p < 0.001), whereas clindamycin utilization increased (p < 0.05). PubMed searches of "erythromycin AND resistance" and "clindamycin AND resistance" demonstrated increasing publication frequency by year, fit with sigmoidal functions (erythromycin: R2=0.93 and clindamycin: R2=0.94). Yearly publications consistently exceeded 100 papers for erythromycin and clindamycin resistance in 1983 and 2003, respectively, roughly corresponding to the interval between reports of their utility in acne.
  
  
  CONCLUSIONS
  Our findings suggest topical erythromycin use for acne has essentially ceased. By contrast, clindamycin use is increasing. Current recommendations discourage topical antibiotic monotherapy in favor of combination therapy with benzoyl peroxide and topical retinoids. Our group's previous work demonstrated that this trend is indeed occurring.
authors.affiliation: a Department of Surgery, Division of Dermatology , University of Kentucky College of Medicine , Lexington , KY , USA.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Austin
authors.affiliation: a Department of Surgery, Division of Dermatology , University of Kentucky College of Medicine , Lexington , KY , USA.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Fleischer
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy* / Q000453:epidemiology; D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001585:Benzoyl Peroxide / Q000627:therapeutic use; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D004917:Erythromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends; D012176:Retinoids / Q000627:therapeutic use; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D012176:Retinoids; D002981:Clindamycin; D004917:Erythromycin; D001585:Benzoyl Peroxide
keywords: Bacterial resistance; health services research; prescriber behavior