A survey of UK-based dermatologists and Outpatient Parenteral Antimicrobial Therapy centres to evaluate the use of intravenous antibiotics as a treatment for hidradenitis suppurativa.

Background: Case series have indicated that intravenous antibiotics may be effective in severe hidradenitis suppurativa (HS) treatment. This treatment approach is excluded from the British Association of Dermatologists UK HS treatment guidelines but can be found in the European S2k, North American and French Dermatology Society HS guidelines. Objectives: To study whether intravenous antibiotics are being used in HS treatment in the UK and to explore the experiences of dermatologists and outpatient parenteral antibiotic therapy (OPAT) teams with intravenous antibiotics. Methods: Two separate surveys were distributed to dermatologists and OPAT centres respectively in 2020. The surveys were designed on Survey Monkey Results: Seventy-four dermatology clinicians and 25 OPAT centres responded. Nearly half of the respondents reported having treated HS with intravenous antibiotics. Most used intravenous ertapenem for an average treatment duration of 4-6 weeks with 1-3 months of average remission period. Top indications were severe disease (57%) and biologic treatment failure (57%). The most common consolidation treatments were biologics, surgery and tetracycline antibiotics. A joint dermatology-OPAT HS clinic was preferred. Dermatologists reported exclusion of intravenous antibiotics from local/national guidelines (67%) being the main barrier to using intravenous antibiotics. Conclusion: Findings from the two surveys show overall positive experience using intravenous antibiotics in HS treatment and call for development of a best practice statement in HS treatment with intravenous antibiotics and collaborative working with OPAT for a national referral pathway.