Objective: This study aims to evaluate concordance with guidelines written by the AAD for the treatment of acne vulgaris with an emphasis on use of systemic antibiotic therapy and topical retinoids. Guidelines published by the AAD recommend treating acne vulgaris with oral antibiotics for no more than 6 months and with the concomitant use of a topical retinoid. Our objective is to determine if prescribing behaviors of general practitioners and dermatologists for the treatment of acne in the United States and other countries are in accordance with these guidelines.

Rationale: Acne vulgaris is one of the most common inflammatory skin disorders, especially among adolescents. Quality of life is often affected in patients with acne,1 but side effects of systemic antibiotic therapy can be significant, and include inflammatory bowel disease (IBD), candida vulvovaginitis, photosensitivity, and drug eruptions. The American Academy of Dermatology (AAD) has published guidelines informing use of systemic antibiotics for the management of acne. Tetracylines are recommended as first-line antibiotic therapy. The duration of therapy is advised be as short as possible, ideally 3-4 months and no longer than 6 months.2 This is in line with antibiotic stewardship and a desire to minimize antibiotic resistance. Monotherapy with oral antibiotics is strongly discouraged and concomitant treatment with a topical retinoid or topical retinoid/benzoyl peroxide is strongly recommended to increase efficacy. A large retrospective cohort study assessing the medical management of acne among teenagers in the United Kingdom found that of antibiotic courses prescribed by general practitioners, 62% were not associated with a topical retinoid and 29% exceeded 6 months in duration.3 The conclusion of this study was that prescribing behavior for oral antibiotics for the treatment of acne by general practitioners was not aligned with current AAD recommendations. Our study aims to determine concordance with AAD recommendations among general practitioners and dermatologists in the United States and other countries for the management of acne with oral antibiotics. To achieve this aim, we will analyze data from the OHDSI database. We would also like to include as many other countries as possible depending on availability of information within the OHDSI system. References: 1. Unal D, Emiroglu N, Cengiz FP. Evaluation of social anxiety, self-esteem, life quality in adolescents with acne vulgaris. International journal of adolescent medicine and health. 2016. 2. Zaenglein
 AL, Pathy AL, Schlosser BJ, et. al. Guidelines of care for the management of acne vulgaris. J Am Acad Deramtol 2016;74:945-73. 3. Barbieri JS, Hoffstad O, Margolis DJ. Duration of oral tetracycline-class antibiotic therapy and use of topical retinoids for the treatment of acne among general practitioners (GP): A retrospective cohort study. J Am Acad Dermatol 2016.

Project Lead(s): Stephanie Chapman, Renee Domozych, Jessica Mounessa, Robert P. Dellavalle, Lisa Schilling

Coordinating Institution(s): University of Colorado School of Medicine

Additional Participants:

Full Protocol:

Initial Proposal Date: August 25, 2016

Launch Date: TBD

Study Closure Date: TBD

Results Submission: [mailto:Lisa.Schilling@ucdenver.edu]