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QuestionsÌý Which factors affect long-term oral antibiotic prescribing for acne?

FindingsÌý This qualitative study of 30 stakeholders found that knowledge of guideline recommendations on limiting antibiotic prescribing was high and most believed that antibiotic stewardship is a professional responsibility. Perceived lack of evidence to justify practice changes, difficulty navigating patient demands and satisfaction, discomfort with discussing contraception, iPLEDGE-related barriers, and the absence of an effective system to measure progress of antibiotic stewardship were reported to affect prescribing practices.

MeaningÌý These findings suggest that the design and implementation of an antibiotic stewardship program in acne is needed and should address multiple salient factors in clinical dermatology practices.

ImportanceÌý Dermatologists prescribe more oral antibiotics per clinician than clinicians in any other specialty. Despite clinical guidelines that recommend limitation of long-term oral antibiotic treatments for acne to less than 3 months, there is little evidence to guide the design and implementation of an antibiotic stewardship program in clinical practice.

ObjectiveÌý To identify salient barriers and facilitators to long-term antibiotic prescriptions for acne treatment.

Design, Setting, and ParticipantsÌý This qualitative study assessed data collected from stakeholders (including dermatologists, infectious disease physicians, dermatology resident physicians, and nonphysician clinicians) via an online survey and semistructured video interviews between March and August 2021. Data analyses were performed from August 12, 2021, to January 20, 2024.

Main Outcomes and MeasuresÌý Online survey and qualitative video interviews developed with the Theoretical Domains Framework. Thematic analyses were used to identify salient themes on barriers and facilitators to long-term antibiotic prescriptions for acne treatment.

ResultsÌý Among 30 participants (14 [47%] males and 16 [53%] females) who completed the study requirements and were included in the analysis, knowledge of antibiotic guideline recommendations was high and antibiotic stewardship was believed to be a professional responsibility. Five salient themes were to be affecting long-term antibiotic prescriptions: perceived lack of evidence to justify change in dermatologic practice, difficulty navigating patient demands and satisfaction, discomfort with discussing contraception, iPLEDGE-related barriers, and the absence of an effective system to measure progress on antibiotic stewardship.

Conclusions and RelevanceÌý The findings of this qualitative study indicate that multiple salient factors affect long-term antibiotic prescribing practices for acne treatment. These factors should be considered in the design and implementation of any future outpatient antibiotic stewardship program for clinical dermatology.