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    Acne: lymecycline combination therapy

    GID-IND10343: The percentage of patients with acne aged 12 years or over currently treated with lymecycline who are also prescribed a topical treatment.

    Indicator type

    General practice indicator suitable for use in the QOF.

    Rationale

    Using oral antibiotics as monotherapy for acne has lower clinical and cost effectiveness compared with combined treatment options in moderate to severe acne, and no clinical effectiveness in mild to moderate acne. Effective treatment should lead to lower long-term antibiotic prescribing for acne and reduce the risk of antimicrobial resistance.

    Source guidance

    NICE's guideline on acne vulgaris (2021) recommendations 1.5.1 and 1.5.11.

    Specification

    Numerator: The number of patients in the denominator prescribed a topical treatment.

    Denominator: The number of patients with acne aged 12 years or over currently treated with lymecycline.

    Definitions: Patients with acne includes any patients with a recorded diagnosis of acne vulgaris at any time in the 12-month reporting period.

    Current treatment with lymecycline is defined as a prescription of lymecycline in the last 6 months of the reporting period.

    Topical treatment is defined as:

    • 0.1% adapalene with 2.5% benzoyl peroxide

    • 0.3% adapalene with 2.5% benzoyl peroxide

    • 15% azelaic acid

    • 20% azelaic acid

    Exclusions: None

    Question for consultation:

    22. NICE's guideline on acne vulgaris also recommends doxycycline as an antibiotic treatment option, which has a narrower spectrum of activity and lower resistance potential than lymecycline. However, clinical opinion indicated lymecycline was the most common antibiotic for acne. Is it therefore appropriate for the indicators to focus on lymecycline? Is there a risk that, if incentivised, the indicators could increase use of lymecycline over doxycycline?

    23. Lymecycline can be prescribed for indications other than acne (though is used mainly for acne). Is it appropriate for the proposed indicators to assume that lymecycline is prescribed for treatment of acne if there is a relevant acne diagnosis at any time in the 12-month reporting period?

    24. Topical treatment can be purchased over-the-counter and may be cheaper than a prescription charge. If advice on topical treatment is recorded as free text in general practice records, patients would not be included in the numerator. Is it likely that patients are advised to purchase topical treatment over-the-counter?

    25. In practice, is single-agent benzoyl peroxide also being used as topical treatment when oral antibiotics are prescribed for acne?