The more potent drug, isotretinoin, sold as Accutane, carries potential side effects that include complications in pregnancy and depression.
Researchers found there was often a lag of six months or more from the first time Accutane was mentioned to patients to when it was prescribed for them. For some reason, the researchers said, doctors often ignore clinical guidelines that recommend antibiotic therapy be limited to two or three months at a time unless significant improvements are seen.
"Acne remains the number one reason for young people to visit a dermatologist, and there are no other medications as effective as isotretinoin for treating severe cases of the skin condition," said Dr. Arielle Nagler, a dermatologist at NYU Langone Medical Center, in a press release. "We need to find a better balance between trying antibiotics that may work and getting isotretinoin quickly to patients for whom antibiotics are not working.
The researchers performed a retrospective review of 137 patients' records, finding that patients were on antibiotics for an average of 331.3 days. Most patients were treated with antibiotics far longer than recommended duration of time -- 15.3 percent of patients used them for three months or less, 64.2 percent of were given antibiotics for six months or more, and 33.6 percent used them for a year or longer.
Additionally, patients treated only at the dermatological practice involved with the study had a mean duration of antibiotic treatment of 283.1 days while those who were previously treated with antibiotics at another practice had a mean duration of treatment of 380.2 days.
Overuse of antibiotics has contributed to some having diminishing effects, while some pathogens have adapted to resist the drugs. Researchers say keeping patients on antibiotic treatments when they clearly are not working is a bad choice -- hence guidelines that suggest trying a different antibiotic within a few months, if not switching to another type of drug entirely.
"Physicians also need to start talking to their acne patients earlier about possible isotretinoin therapy, so when and if they do need to switch to it, patients are more receptive to the drug and any concerns about side effects have already begun to be addressed," Nagler said.
The study is published in the Journal of the American Academy of Dermatology.
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