Affecting 85-100% of the worldâ€™s population at some time in their lives, acne vulgaris has been treated with long-term courses of antibiotics since the 1960s.1,2 The pathogenesis of this extremely common condition consists of four main processes, including: an androgen-stimulated increase in sebum production; creation of a microcomedo through follicular hyperkeratinization; proliferation of propionibacteria (mainly Propionibacterium acnes [P. acnes]) within the sebaceous follicle; and inflammation.2 Antibiotics reduce inflammation as well as target propionibacteria residing in the hair follicle. When the efficacy of antibiotic treatment for acne was first established, it was believed that cutaneous propionibacteria were incapable of becoming resistant, as a resistant organism could not be detected at that time.1 This belief was shattered by the first documentation of antibiotic-resistant propionibacteria in acne patients in 1979. This report indicated that one in five patients being treated topically with erythromycin or clindamycin in the United States (U.S.) had antibiotic resistant strains on their skin.3 Similar reports surfaced globally.4
Over 20 years later, the problem of antibiotic resistance has grown. Eco-responsible practice encompasses considering the worldwide problem of antibiotic resistance, the impact prescribing antibiotics can have with every treatment decision and prescribing the antibiotics only if the benefits outweigh the risksâ€” including the risk of resistanceâ€”and only for the treatment duration necessary for these benefits. The aim of this study was to assess the trends in prescribing antibiotics for acne from 1997−2006. Additionally, using current treatment guidelines and recommendations from the literature for prevention of antimicrobial resistance, the authors offer suggestions for a more eco-responsible approach to treating acne vulgaris.
The National Ambulatory Medical Care Survey (NAMCS) database was analyzed for trends in prescriptions for acne vulgaris from 1997−2006. The NAMCS collects nationwide outpatient data from U.S. non-federally employed physicians and uses a multi-stage probability design with the primary sampling unit consisting of the physician office visit. The NAMCS uses the term drug â€œmentionâ€ to include medications that are either discussed by the physician and patient, currently taken by the patient, administered in office, or prescribed by the physician. For the purposes of this analyses, the authors assume that a mention refers to a new prescrip-