Study Highlights Factors Affecting Antibiotic Prescribing Practices for Acne Treatment

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This study’s investigators point to the necessity of adapting an antibiotic stewardship program for acne treatment, with evaluation being done in dermatology practices to assess performance.

Several important factors impact the long-term antibiotic prescribing practices for treatment of acne, according to new findings, including such elements as issues with navigating the demands and satisfaction of patients and general discomfort with contraception discussions.1

There are more oral antibiotics prescribed per physician among dermatologists than doctors of any other type. Yet despite recommendations of limiting long-term oral treatment with antibiotics, there has been little data to guide an antibiotic stewardship program’s implementation within clinical settings.

In this new research, led by Ronnie A. Festok, BA, from the department of dermatology at Emory University School of Medicine in Atlanta, the investigators sought to point out any salient barriers or facilitators to the long-term prescriptions of acne therapy antibiotics.

“Successful design and implementation of antibiotic stewardship programs in dermatology require careful consideration of the clinical factors associated with long-term antibiotic treatment for acne, including clinician and patient values, institutional context, and resources,” Festok and colleagues wrote.“ 2

Background and Methods

The research team utilized the Theoretical Domains Framework (TDF) for the purposes of guiding their study’s design, overall conduct, and interpretation, with the goal being to evaluate clinician behavior across 14 different domains.1

They sampled expert and diverse stakeholders purposefully, looking at dermatology residents, community and academic dermatologists, infectious disease clinicians with specialization in antimicrobial stewardship, and advanced practice practitioners in the field. The team specifically included infectious disease physicians to gain better insight into the implementation of outpatient antibiotic stewardship interventions.

They conducted recruitment of these subjects using email and several different professional listservs from March - August 2021. The study’s investigators managed data coding, study procedures, and thematic analyses independently from one another.

The subjects were ensured anonymity, and the interviews the research team conducted were focused on the identification of barriers and facilitators to long-term antibiotics for treatment of acne. The team’s collection of data included an online survey conducted to assess demographic and clinical practice information, and this was later followed by 45 - 60-minute semistructured interviews done through the use of video conferencing.

Their recordings of interview audio were later transcribed verbatim thanks to several professionals, with the thematic analysis being performed without the use of field notes.


The investigators had 30 total participants in their analysis, with 47% being male and 53% female, who all had fulfilled the team’s criteria for inclusion and became a part of the analysis. Overall, the team found that there had been a high level of awareness regarding antibiotic guideline recommendations, and the subjects noted that antibiotic stewardship was a professional obligation.

The research team managed to report on 5 key themes in their assessment which impacted the prolonged use of antibiotics: barriers connected to iPLEDGE requirements, issues with the management of patient satisfaction and overall expectations, the perception of insufficiency of evidence to support alterations in dermatologic practices, discomfort in conversing about contraception, and the general absence of a useful mechanism for the monitoring of progress in antibiotic stewardship actions.

As far as limitations, while the investigators’ qualitative inquiry had not been conducted to produce universally applicable findings, the majority of their study participants were White academic clinicians who were also based in the US, primarily dealing with a limited number of individuals with acne. The analysis had also not encompassed practitioners from diverse cultural, clinical, or international backgrounds.

Nevertheless, the research team’s results could affect future quantitative investigations, including surveys that implement modified versions of the Influences on Patient Safety Behaviors Questionnaire or other such tools. These future studies could end up generating universally applicable data related to the relative significance of obstacles and facilitators across various types of environments.

The research team added that the Incorporation of diverse viewpoints among different patients may help to enhance the formulation of different interventions for acne antibiotic stewardship.

“An antibiotic stewardship program for acne treatment should be adapted, piloted, and evaluated in dermatology practices to assess its acceptability, feasibility, and effectiveness,” they concluded.


  1. Festok RA, Ahuja AS, Chen JY, et al. Barriers and Facilitators Affecting Long-Term Antibiotic Prescriptions for Acne Treatment. JAMA Dermatol. Published online April 03, 2024. doi:10.1001/jamadermatol.2024.0203.
  2. Chu L, Yeung H. Developing and implementing approaches to limit antimicrobial resistance. J Am Acad Dermatol. 2022;87(5):e187-e188. doi:10.1016/j.jaad.2022.03.069.