I was recently asked to write an editorial for the Journal of Dermatological Treatment regarding the manuscript, “Prevention of chronic furunculosis with low-dose azithromycin.”
In this case series, Aminzadeh, et al., successfully used once-weekly azithromycin to treat chronic furunculosis in 24 patients. However, with the rise of antibiotic resistance, especially community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), should dermatologists be more cautious regarding the drugs we choose to treat our patients? Moreover, are we contributing to the rise in antibiotic resistance?
CA-MRSA On The Rise
The increase of CA-MRSA is well documented. A study by Fridkin, et al., evaluated MRSA isolates from Atlanta, Baltimore and Minnesota.1 From 2001 through 2002, 1,647 cases of CA-MRSA infection were reported, representing between 8% and 20% of all MRSA isolates. Seventy three percent of MRSA isolates were resistant to prescribed antimicrobial agents. Twenty three percent of patients required hospitalization. There are also reports of CA-MRSA in prison inmates2 and athletes.3,4
How Dermatologists Use Antibiotics
Dermatologists use antibiotics to treat multiple infectious as well as inflammatory diseases. Many of these diseases are chronic and require long-term antibiotic use. In certain disease states, such as acne vulgaris and acne rosacea, there are not enough safe and effective non-antibiotic alternatives, although the new 40-mg, slow-release doxycycline (Oracea) is promising. The need for alternatives is now ever greater, since iPLEDGE makes isotretinoin use very difficult.
For many superficial infections, such as “infected” cysts, a simple incision and drainage procedure has been recommended and antibiotic therapy may not be necessary in a large number of patients if proper drainage is performed.2 Furthermore, in the study by Fridkin, et al., 73% of MRSA isolated were resistant to a prescribed antibacterial agent.1 Therefore, it may be prudent to
perform a bacterial culture to ensure proper antibacterial coverage.
Overusing Antibiotics
But are our prescribing habits contributing to the rise of antibiotic resistance? I believe dermatologists, like all physicians, overuse antibiotics.
I am certainly guilty of this. There are times when a patient believes he or she “needs” an antibiotic for his or her
“infection,” and my knee-jerk response is to prescribe a short course of an antibiotic.
There are also medical-legal pressures if the patient is convinced his or her illness is infectious in nature. Therefore, patient education is needed to decrease the number of knee-jerk antibiotic prescriptions we dole out.
We, as physicians, have an obligation to try to combat this serious issue of CA-MRSA. It’s imperative to choose the correct antibiotic when treating true infections of the skin. And, non-antibiotic agents are needed to help us treat chronic dermatoses with an inflammatory component, such as acne vulgaris and acne rosacea.
I was recently asked to write an editorial for the Journal of Dermatological Treatment regarding the manuscript, “Prevention of chronic furunculosis with low-dose azithromycin.”
In this case series, Aminzadeh, et al., successfully used once-weekly azithromycin to treat chronic furunculosis in 24 patients. However, with the rise of antibiotic resistance, especially community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), should dermatologists be more cautious regarding the drugs we choose to treat our patients? Moreover, are we contributing to the rise in antibiotic resistance?
CA-MRSA On The Rise
The increase of CA-MRSA is well documented. A study by Fridkin, et al., evaluated MRSA isolates from Atlanta, Baltimore and Minnesota.1 From 2001 through 2002, 1,647 cases of CA-MRSA infection were reported, representing between 8% and 20% of all MRSA isolates. Seventy three percent of MRSA isolates were resistant to prescribed antimicrobial agents. Twenty three percent of patients required hospitalization. There are also reports of CA-MRSA in prison inmates2 and athletes.3,4
How Dermatologists Use Antibiotics
Dermatologists use antibiotics to treat multiple infectious as well as inflammatory diseases. Many of these diseases are chronic and require long-term antibiotic use. In certain disease states, such as acne vulgaris and acne rosacea, there are not enough safe and effective non-antibiotic alternatives, although the new 40-mg, slow-release doxycycline (Oracea) is promising. The need for alternatives is now ever greater, since iPLEDGE makes isotretinoin use very difficult.
For many superficial infections, such as “infected” cysts, a simple incision and drainage procedure has been recommended and antibiotic therapy may not be necessary in a large number of patients if proper drainage is performed.2 Furthermore, in the study by Fridkin, et al., 73% of MRSA isolated were resistant to a prescribed antibacterial agent.1 Therefore, it may be prudent to
perform a bacterial culture to ensure proper antibacterial coverage.
Overusing Antibiotics
But are our prescribing habits contributing to the rise of antibiotic resistance? I believe dermatologists, like all physicians, overuse antibiotics.
I am certainly guilty of this. There are times when a patient believes he or she “needs” an antibiotic for his or her
“infection,” and my knee-jerk response is to prescribe a short course of an antibiotic.
There are also medical-legal pressures if the patient is convinced his or her illness is infectious in nature. Therefore, patient education is needed to decrease the number of knee-jerk antibiotic prescriptions we dole out.
We, as physicians, have an obligation to try to combat this serious issue of CA-MRSA. It’s imperative to choose the correct antibiotic when treating true infections of the skin. And, non-antibiotic agents are needed to help us treat chronic dermatoses with an inflammatory component, such as acne vulgaris and acne rosacea.
I was recently asked to write an editorial for the Journal of Dermatological Treatment regarding the manuscript, “Prevention of chronic furunculosis with low-dose azithromycin.”
In this case series, Aminzadeh, et al., successfully used once-weekly azithromycin to treat chronic furunculosis in 24 patients. However, with the rise of antibiotic resistance, especially community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), should dermatologists be more cautious regarding the drugs we choose to treat our patients? Moreover, are we contributing to the rise in antibiotic resistance?
CA-MRSA On The Rise
The increase of CA-MRSA is well documented. A study by Fridkin, et al., evaluated MRSA isolates from Atlanta, Baltimore and Minnesota.1 From 2001 through 2002, 1,647 cases of CA-MRSA infection were reported, representing between 8% and 20% of all MRSA isolates. Seventy three percent of MRSA isolates were resistant to prescribed antimicrobial agents. Twenty three percent of patients required hospitalization. There are also reports of CA-MRSA in prison inmates2 and athletes.3,4
How Dermatologists Use Antibiotics
Dermatologists use antibiotics to treat multiple infectious as well as inflammatory diseases. Many of these diseases are chronic and require long-term antibiotic use. In certain disease states, such as acne vulgaris and acne rosacea, there are not enough safe and effective non-antibiotic alternatives, although the new 40-mg, slow-release doxycycline (Oracea) is promising. The need for alternatives is now ever greater, since iPLEDGE makes isotretinoin use very difficult.
For many superficial infections, such as “infected” cysts, a simple incision and drainage procedure has been recommended and antibiotic therapy may not be necessary in a large number of patients if proper drainage is performed.2 Furthermore, in the study by Fridkin, et al., 73% of MRSA isolated were resistant to a prescribed antibacterial agent.1 Therefore, it may be prudent to
perform a bacterial culture to ensure proper antibacterial coverage.
Overusing Antibiotics
But are our prescribing habits contributing to the rise of antibiotic resistance? I believe dermatologists, like all physicians, overuse antibiotics.
I am certainly guilty of this. There are times when a patient believes he or she “needs” an antibiotic for his or her
“infection,” and my knee-jerk response is to prescribe a short course of an antibiotic.
There are also medical-legal pressures if the patient is convinced his or her illness is infectious in nature. Therefore, patient education is needed to decrease the number of knee-jerk antibiotic prescriptions we dole out.
We, as physicians, have an obligation to try to combat this serious issue of CA-MRSA. It’s imperative to choose the correct antibiotic when treating true infections of the skin. And, non-antibiotic agents are needed to help us treat chronic dermatoses with an inflammatory component, such as acne vulgaris and acne rosacea.
