Acne, or ‘spots’, affect almost everyone. Doctors sometimes prescribe antibiotics to treat acne. Most people find antibiotics improve their acne, not because acne is an infection, but because antibiotics lessen the redness of spots. Using antibiotics does not stop spots coming back. Acne treatment guidelines recommend repeated courses of antibiotics, each lasting 3-6 months. Antibiotic courses can be given intermittently over many years.
Unfortunately, some bugs (bacteria) become resistant to antibiotics. If we use antibiotics too often or for too long, bacteria develop ways to avoid antibiotics. This is important because it means that antibiotics used to treat infections stop working; this is called antimicrobial resistance. Scientists have predicted by 2050, 10 million people per year will die because some antibiotics no longer work.
It is possible that repeated antibiotic courses, potentially given over many years, to treat acne may contribute to antimicrobial resistance. Our study will use large amounts of information that is collected when people visit their doctor to explore how antibiotics for acne might contribute to antimicrobial resistance. We will look at how well people respond to antibiotics for common infections after they have had antibiotic tablets for acne compared to people who did not get antibiotic tablets for their acne (e.g., did they need to switch to an alternative antibiotic after the first antibiotic was prescribed?). Our study will compare whether antibiotics are less effective in treating infections in people with acne who have had long-term antibiotics to those with acne who haven’t had long-term antibiotics.
Long-term antibiotics for acne may contribute to antimicrobial resistance potentially leading to antibiotic treatment failure (i.e., when an antibiotic fails to effectively treat an infection due to antimicrobial resistance). Our aim is to establish if oral antibiotics for acne contribute to antibiotic treatment failure when antibiotics are prescribed for common infections (i.e., lower respiratory tract, skin/soft tissues, urinary tract). As we cannot directly capture antimicrobial resistance in electronic health records, we will use antibiotic treatment failure as a proxy.
We will undertake a cohort study to compare antibiotic treatment failure (i.e., prescription of an alternative antibiotic, or infection-related hospital admission, for common infections [lower respiratory tract, skin/soft tissue, urinary tract]) in people with acne who have been treated with long-term oral antibiotics (prescription of 28 days or more for antibiotic classes used to treat acne: tetracyclines, macrolides, trimethoprim, recorded on or after first acne diagnosis) to people with acne who have not been treated with long-term oral antibiotics.
Our study population will include individuals (aged 8-50) who have received an acne diagnostic code between the 1st of January 2004 and the 31st of December 2019.
We will follow individuals from date of first non-acne antibiotic within one week following a specific infection after initial acne diagnosis.
We will use Cox regression to estimate hazard ratios (95% confidence intervals), comparing antibiotic failure in those with acne who have been treated with long-term oral antibiotics compared to those with acne not treated with long term oral antibiotics, adjusted for confounders including age, sex, recent hospitalisation, and other medical conditions.
Alternative antibiotic prescription following an initial antibiotic prescribed for a common infection; infection-related hospital admission following an initial antibiotic prescribed for a common infection
The outcomes above refer to three common infections: lower respiratory tract (LRTI); skin and soft tissue (SSTI) and urinary tract (UTI) infections.
Sinead Langan - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Ketaki Bhate - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Clemence Leyrat - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Kathryn Mansfield - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Laura Shallcross - Collaborator - University College London ( UCL )
Nick Francis - Collaborator - University of Southampton
Richard Stabler - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Rohini Mathur - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Sarah-Jo Sinnott - Collaborator - Genzyme Corporation (USA)
Susan Hopkins - Collaborator - Royal Free London NHS Foundation Trust
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation