Dr. Emmy Graber discusses several ways dermatologists can practice good antibiotic stewardship when treating acne patients.
Emmy Graber, MD, MBA, President, The Dermatology Institute of Boston, and Affiliate Clinical Instructor, Northeastern University, Boston, Massachusetts
“Antibiotic stewardship… is a term that we’re throwing around a lot these days and it’s an initiative, really, to promote the appropriate use of antibiotics so that patients receive the right dose of the right antibiotic at the right time for the right duration,” said Emmy Graber, MD, MBA, who co-presented “Practicing Good Antibiotic Stewardship When Treating Acne” with Christopher Bunick, MD, PhD, at the 2022 Fall Clinical Conference®.
“…we talked about three patient cases when a patient may need an oral antibiotic, and what is the right selection and how sarecycline can be a part of antibiotic stewardship.”
According to Dr. Graber, Cutibacterium acnes resistance is prevalent and growing, though it varies by country.
“The use of narrow spectrum antibiotics such as sarecycline really can minimize resistance. Sarecycline, as a narrow spectrum antibiotic, has a lower side effect profile than some of our broad spectrum antibiotics. There’s a very low incidence of photosensitivity and a very low incidence of vestibular side effects.”
Combine for Compliance
When prescribing an oral antibiotic for the treatment of acne, combine it with other treatments, said Dr. Graber.
“Whenever we use oral antibiotics, it is good practice to also use combination therapy, such as doing a benzoyl peroxide product with an oral antibiotic and using a topical retinoid so that there is some long-term solution–not just giving antibiotics for a few months.”
Combination therapy also improves compliance, said Dr. Graber.
“In patients who you’re going to add on, say a topical agent, you may want to choose one of the combination agents that have two ingredients in them rather than just one active.”
Improve Skin and Well-Being
Acne can have a significant psychological impact on patients who suffer with acne, said Dr. Graber.
“There’s a recent study that was presented at the Fall Clinical meeting, the PROSES study, that was done after looking at [acne] patients’ mental well-being… before treatment and after 12 weeks of using sarecycline. This study was done using some of the old questionnaire tools that we had to ask patients about their quality of life, but also there [was] a group of eight of us that created a new expert panel questionnaire to bring patients into 2022 to capture their mental health.”
For example, one question was, “How often do you filter your social media pictures because of your acne?”
Results showed that both physical and mental health were improved after treatment for 12 weeks with sarecycline, she said.
“And so we need to remember the big psychological impact that acne has, but also the impact that we can have as dermatologists to improve not only their skin but also their psychological well-being.”
Myths and Modalities
According to Dr. Graber, oral tetracyclines do not impact the efficacy of oral contraceptives, an important point since oral antibiotics are often used alongside oral contraceptive pills to treat acne.
“Dr. Bunick and I reiterated the point… [It] seems to be kind of a long-standing myth that any antibiotic may impact the efficacy of oral contraceptives and that’s just not true. And so you can safely prescribe any of the oral tetracyclines and have your patients still use their oral contraceptive without it impacting its efficacy.”
Finally, using oral sarecycline in combination with other modalities such as oral Spironolactone, which has an extended wait for onset of action, helps patients to see results sooner, said Dr. Graber.
“Dr. Bunick and I both agreed using oral sarecycline concomitantly is something that we do in our practices to help patients see a faster improvement.”
