Observational Health Data Sciences and Informatics

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=====Characterization of Oral Antibiotic and Isotretinoin Therapy for Acne======

**Objective:** 
1. Describe the prevalence of systemic antibiotic treatment for acne by age and gender and to compare how systemic antibiotic prevalence for acne varies by country.
2. Describe the prevalence of systemic isotretinoin treatment for acne by age and gender and to compare how systemic isotretinoin prevalence for acne varies by country.
3. Characterize systemic antibiotic use for acne by type, dose, course duration,  number of courses, and pathway course (which antibiotic started first) by age and gender and to compare how this use varies by country.
4. Characterize systemic isotretinoin use for acne by dose, course duration, number of courses by age and gender and to compare how this use varies by country.
5. Examine the frequency and duration of antibiotic use prior to isotretinoin prescribing (ie  How long course of antibiotics before a patient is switched to isotretinoin) varies by data source and country. 


//**Rationale:** //
Acne is a common and disabling medical condition, particularly amongst adolescents and young adults.1 According to the Global Burden of Disease Study 2016, acne is the most disabling skin condition worldwide.2 In addition to physical disfigurement, the profound psychosocial effects of acne have been recognized for over half a century.3  Guidelines established by the American Academy of Dermatology recommend minimizing the duration of systemic antibiotics for the management of acne to the shortest possible duration, ideally to 3-4 months, in order to decrease the risk of bacterial resistance.1  A recent systematic review demonstrated that over 50% of P. acnes strains are reported as resistant in all major regions of the world.4  In addition to promoting resistance, long-term oral antibiotic use has been associated with a number of adverse events including microbiome disruption and pharyngitis, as well as possible associations with inflammatory bowel disease and obesity.5 Despite these adverse effects, oral antibiotics are often prescribed for acne for longer durations than acne guidelines recommend.5  A large retrospective cohort study of teenagers in the UK revealed that 29% of antibiotic courses prescribed by general practitioners exceeded 6 months in duration.5  A similar retrospective cohort study of teenagers and young adults in the US found that 18% of antibiotic courses exceeded 6 months.6  Our study will investigate oral antibiotic use for acne over the last five years across the globe in both pediatric/young adult and adult populations.  OHDSI network evidence will identify areas of the globe most in need of improving guideline concordance//.//

**Project Lead(s):**  //Robert P. Dellavalle, Lisa M. Schilling//

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

**Additional Participants:** //Chandler Rundle: chandler.rundle@gmail.com; Chante Karimkhani: ck2525@caa.columbia.edu; 
Megan Branda: MEGAN.BRANDA@cuanschutz.edu;
John Barbieri: john.barbieri@uphs.upenn.edu;
Chris Knoll: cknoll1@its.jnj.com;
David Margolis: margo@mail.med.upenn.edu;
Patrick Ryan: ryan@ohdsi.org;
Martijn Schuemie: m.schuemie@erasmusmc.nl;
Jonathan Silverberg: JonathanISilverberg@gmail.com; 
Dylan Ray: DYLAN.RAY@cuanschutz.edu;
Sara Deakyne: Sara.DeakyneDavies@childrenscolorado.org//

**Full Draft Protocol:** //Please provide any comments or suggestions.//
[[https://docs.google.com/document/d/1LnugUQrloOn-3cZJDdTpgVYEsynu7SBztFtjzjAuEDE/edit?usp=sharing]]

**Initial Proposal Date:** //01 January 2020//

**Launch Date:** //  //

**Study Closure Date:** // //

**Forum Discussion Thread**

http://forums.ohdsi.org/t/ohdsi-study-concordance-with-antibiotic-treatment-guidelines-for-acne/1703