Dermatologists Continue to Prescribe Topical Antibiotics After Biopsies, Excisions

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Clinical prescribing practices for topical antibiotics after dermatologic procedures do not align with recommendations put forth by the Centers for Disease Control and Prevention.

Dermatologists who perform excisions and biopsies frequently recommend topical antibiotics to their patients, despite evidence-based guidelines recommending the avoidance of postsurgery topical antibiotic therapies, study research published in the Journal of the American Academy of Dermatology finds.

Researchers examined the frequency of topical antibiotic use and its association with biopsies and excisions between 2006 and 2015 using data from the National Ambulatory Medical Care Survey (NAMCS). The frequency of topical antibiotic use after clean biopsies and excisions, stratified by comparisons between dermatologists and nondermatologists, was examined using logistic regression analyses.

The estimated percentages of topical antibiotic prescriptions each year between 2014 and 2015 were 10.2% with biopsies and 5.7% with excisions. An estimated 1.9% and 5.3% of topical antibiotic prescriptions each year in 2014 and 2015 were associated with biopsies and excisions, respectively, in patients seen by nondermatologists.

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The odds of postbiopsy receipt of a topical antibiotic declined initially among dermatologists, with the lowest point in 2010 and 2011 (odds ratio [OR], 0.20; 95% CI, 0.06-0.63). Conversely, the odds increased back to baseline in the following years. The odds of a postbiopsy receipt of a topical antibiotic among nondermatologists remained mostly unchanged, except in 2012 and 2013 (OR, 3.98; 95% CI, 1.07- 14.82). The odds of a postexcision receipt of a topical antibiotic increased throughout the study period and peaked in 2014 and 2015 (OR, 5.16; 95% CI, 1.77-14.99).

A limitation of the study was the NAMCS’ lack of data on the patients’ use of over-the-counter topical antibiotics and in-office samples.

The investigators wrote that additional research is “needed to understand the factors driving this persistent prescribing and to identify how to optimize topical antibiotic use to improve patient outcomes and prevent resistance in the community.”

Disclosure: A study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Fathy R, Chu B, James WD, Barbieri JS. The frequency of topical antibiotic use following biopsy and excision procedures amongst dermatologists and non-dermatologists: 2006-2015 [published online January 9, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2019.12.060