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Journal of the American Academy of Dermatology
Volume 74, n° 2
pages 273-279 (février 2016)
Doi : 10.1016/j.jaad.2015.09.046
accepted : 22 September 2015
Original Articles

The use of oral antibiotics before isotretinoin therapy in patients with acne

Arielle R. Nagler, MD a, Emily C. Milam, AB b, Seth J. Orlow, MD, PhD a,
a Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York 
b New York University School of Medicine, New York, New York 

Reprint requests: Seth J. Orlow, MD, PhD, New York University Dermatology, 240 E 38 St, 11th Floor, New York, NY 10016.

Systemic antibiotics are used widely to treat moderate to severe acne, but increasing antibiotic resistance makes appropriate use a priority.


We sought to determine the duration of systemic antibiotic use in patients with inflammatory/nodulocystic acne who eventually required isotretinoin.


We performed a retrospective, single-site chart review of patients with acne diagnostic codes evaluated January 1, 2005 to December 31, 2014, at a dermatology practice in an academic medical center. Included patients were prescribed isotretinoin during the study period and received 30 days or more of antibiotics.


The average duration of antibiotic use was 331.3 days. In all, 21 patients (15.3%) were prescribed antibiotics for 3 months or less, 88 patients (64.2%) for 6 months or more, and 46 patients (33.6%) for 1 year or longer. Patients treated only at the study site had a mean duration of antibiotic treatment of 283.1 days whereas patients who also received antibiotics from another institution had a mean duration of 380.2 days. This difference approached statistical significance (P  = .054).


This study was limited to a single center.


Expert guidelines recommend responsible use of antibiotics in acne in light of emerging resistance. We found that patients who eventually received isotretinoin had extended exposure to antibiotics, exceeding recommendations. Early recognition of antibiotic failure and the need for isotretinoin can curtail antibiotic use.

The full text of this article is available in PDF format.

Key words : acne, antimicrobial resistance, isotretinoin, systemic antibiotics

 Funding sources: None.
 Disclosure: In the past 12 months, Dr Orlow served as a consultant for Dermira, Galderma, GSK/Stiefel, and Provectus, and as an investigator for Amgen. Dr Nagler and Ms Milam have no conflicts of interest to declare.

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