An audit to evaluate the prescribing of antibiotics for acne against NICE guidelines in a digital setting
Authors: Bagga S , Patel N 
Published: November 2024

Abstract

Introduction
According to NICE guidelines, individuals with moderate to severe acne may be recommended a fixed combination of topical treatment along with either oral lymecycline or doxycycline for a 12-week regimen1. If improvement is observed in these patients, continuation of the oral antibiotic and non-antibiotic-topical treatment for an additional 12 weeks is advised. It's important to adhere to these guidelines and avoid prescribing monotherapy topical antibiotics, monotherapy oral antibiotics, or the combination of topical antibiotics with oral antibiotics2. This audit aims to verify our compliance with these guidelines and ensure the appropriate use of antibiotics in our prescribing within a digital setting where patients undergo photo assessment consultations.

Aim
The objective of this audit is to ascertain our adherence to the NICE acne guidelines regarding the duration of oral antibiotic therapy prescribed and the accurate prescribing of topical treatments in conjunction with the oral antibiotic1. The audit criteria entail ensuring that 100% of consultations result in prescriptions aligning with the following: oral antibiotic treatment not exceeding 6 months, a prescribed non-antibiotic topical treatment alongside oral antibiotics, and avoidance of prescribing a combination of topical antibiotics with oral antibiotics.

Method
A retrospective review was conducted on all consultations involving the prescribing of oral and topical antibiotics from 22.4.2023 to 18.4.2024. Each consultation was assessed for the quantity of oral antibiotics prescribed over a 12-month period and examined for the accompanying topical treatments. Additionally, checks were made to determine if the patient was currently taking any oral or topical antibiotics from other sources, ensuring that antibiotics were not overprescribed and that co-prescribing practices adhered to guidelines. Ethical approval was not required since this is a clinical audit.

Results
The data extraction identified 427 consultations in which patients were prescribed either oral antibiotics (361 cases) or topical antibiotics (Duac-66 cases). In 99% of the consultations, patients were not prescribed oral antibiotics for more than six months. The remaining 1% of patients had already been prescribed oral antibiotics from other sources. It is noted that additional queries should have been conducted to ascertain the duration of antibiotic use prescribed elsewhere.
Furthermore, 99% of consultations adhered to the criteria of prescribing a non-antibiotic topical treatment alongside an oral antibiotic. The remaining 1% involved patients who were already using a topical antibiotic from another source, which should have been further investigated to ensure cessation upon initiation of the prescribed oral antibiotics. In all cases, patients were prescribed an appropriate topical treatment in conjunction with an oral antibiotic from our digital setting.

Discussion
This audit confirms high compliance with NICE guidelines for acne treatment within our digital consultation framework1. Specifically, 99% of consultations adhered to the duration regimen of oral antibiotics, ensuring prescriptions did not exceed six months. Additionally, the majority of cases, correctly included non-antibiotic topical treatments alongside oral antibiotics, minimising the risk of antibiotic resistance. However, slight differences were noted in cases where patients had existing prescriptions from other sources. These findings highlight the effectiveness of our prescribing practices and the importance of thorough patient medication history reviews.

References
1. National Institute for Health and Care Excellence (NICE). Acne vulgaris: management. NICE guideline [NG198]. Published: 25 June 2021. Last updated: 07 December 2023. Available from: https://www.nice.org.uk/guidance/ng198
2. Primary Care Dermatology Society. Acne vulgaris. [Internet]. [cited 2024 Apr 1]. Available from: https://www.pcds.org.uk/clinical-guidance/acne-vulgaris