The People's Perspective on Medicine

Do Dermatologists Prescribe Too Many Antibiotics?

Were you ever prescribed antibiotics for a cold? What about acne? Millions of teenagers may have received too many antibiotics. Are there long-term effects?

Dermatologists love antibiotics. They prescribe proportionately more antibiotics than other medical specialties. Do not take our word for this! Here is a quote from an article in JAMA Dermatology (Jan. 16, 2019): “Dermatologists prescribe more oral antibiotic courses per clinician than any other specialty, and this use puts patients at risk of antibiotic-resistant infections and antibiotic-associated adverse events.” One might conclude from this study that dermatologists do indeed prescribe too many antibiotics.

Too Many Antibiotics and Acne?

Frequently, dermatologists prescribe antibiotics to treat non-infectious conditions such as acne or rosacea. It’s not unusual for a teenager to be prescribed a tetracycline-type antibiotic for years to control blemishes.

In the good old days no one worried about too many antibiotics. Many physicians looked upon such drugs as magic bullets. They were thought to be very safe, even when taken for long periods of time. They were often prescribed for viral infections like colds or flu, even though antibiotics cannot do anything to shorten a viral infection.

Now we know that there are unexpected complications from too many antibiotics. For one thing, such drugs can disrupt the microbiome. And we’re not just talking about the bacteria in the digestive tract. The microbiome of the skin, mouth, lungs and vaginal tract can also be affected (Biochemical Pharmacology, June 15, 2017). We are only beginning to understand the ramifications of the disruptions to our bacterial ecology. Sometimes these changes can last for years (Journal of Antimicrobial Chemotherapy, Nov. 12, 2018).

The scientists who wrote the article in JAMA Dermatology noted:

“This antibiotic use can have clinical consequences, including the development of antimicrobial resistance. Oral antibiotic therapy in the treatment of acne is associated with disruption of the normal oropharyngeal [mouth and throat] flora and resultant pharyngitis.”

They go on to conclude:

“Continuing to develop alternatives to oral antibiotics for noninfectious conditions, such as acne, can improve antibiotic stewardship and decrease complications from antibiotic use.”

Taking Antibiotics with Respect:

Frequent antibiotic use can lead to bacteria developing resistance, so the news from a new study in JAMA Dermatology is encouraging. Between 2008 and 2016, dermatologists prescribed fewer antibiotics overall, dropping from 3 to 2 prescriptions per 100 visits. Antibiotic prescriptions rose, however, for surgical procedures and cysts.

Do you think you were ever prescribed too many antibiotics? Please share your story in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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For many of my college years and beyond I was taking Dermatologist prescribed Tetracycline for acne. Add that to a childhood of taking Penicillin quite often and a diet which included quite a bit of refined sugar products. Skip ahead many years to when I was in my early fifties and I was having quite a variety of medical issues. It took years and many doctor appointments with a variety of specialists to figure out the problem was Candida albicans. Which, by the way, I ended up having to figure out on my own. From my experience most doctors don’t have much,if any, experience with it, and don’t recognize Candida albicans as the debilitating medical problem that it can be.

Gut problems can be ameliorated or stopped altogether by eating the right foods & avoiding the ones that cause trouble. I buy thrift store copies of “Eat Right 4 Your Blood Type” by D’Adamo and Whitney and keep them in my car to give to people who indicate they have a gut problem. I’d offer them to people with acne, but it would be me bringing up the issue and that would be rude. It’s not unusual to have people discuss their food problems in conversations in restaurants. Often, they are a bit or a lot overweight, too. Another sign of eating the wrong foods for one’s blood type. I bless my new doctor for suggesting this diet plan to me.

This book was on the NYT best sellers list some years ago and seems to be forgotten now. Some time ago I almost didn’t get to the OR in time for my stomach ulcer pain; and have been prescribed every purple pill that’s made, and some other colors, too. Nothing improved much, but i did give up coffee, which helped a little. Then my current doctor recommended the blood type diet. What a way to get one’s life back!!!! The can be challenging but the relief is worth getting used to it.

I was given clindamycin off and on for most of a year for a stubborn dental abscess. Finally, I made the decision to have the tooth extracted and get a bridge. During treatment, the clindamycin caused terrible GI effects even though I faithfully took probiotics. Six months later I’m still dealing with intermittent diarrhea, which I’m convinced is a lingering effect of the antibiotic. Sometimes I’ll take more probiotics for a few days and the diarrhea subsides. I hate to even take clindamycin now as a pre-med for dental treatments (I’m allergic to most other choices).

My daughter was on amoxicillin for at least 7+ years for acne prescribed by a dermatologist for which it did help. At age 31 she was diagnosed with Sjögren’s syndrome. I cannot help but to think that the antibiotic overuse caused a leaky gut syndrome set her up for this auto immune disorder at a young age.

I am 70 years old. I was on a maintenance dose of antibiotics (either sumycin or erythromycin) from age 17-30. It was the only remedy that worked for my severe genetic acne. My son, who is now 33, was on a maintenance dose of antibiotics from age 13-30 for severe acne. Again, other remedies like light therapy, etc were tried, but were not successful long term. Did have to find the right antibiotic for him. He tried several antibiotics that worked short-term only. Dermatologist recommended Accutane at age 16 as the “miracle” drug to avoid long term antibiotic use. Ended up in the hospital from serious side effects. Went on erythromycin and continued until age 30.

I was prescribed a low dose of antibiotics for ten years. The Dermatologist assured me they were OK to take. I believe my digestive issues, today, are partly due to those years on antibiotics.

At age 25 I suffered from adult acne and was prescribed tetracycline for the next 15 years. Then I divorced my husband, met a friend who suggested I go to her dermatologist in Atlanta who prescribed Vitamin A palmitate. I have now been taking this for over 40 years; my acne disappeared. Certain foods trigger my acne: high Vitamin C worst culprit.

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