Clinicians within the US could also be overprescribing topical antifungal therapies for pores and skin infections, probably exacerbating a rising drawback of drug resistance, in keeping with a brand new examine.
Final 12 months, a dermatologist in New York reported the nation’s first instances of a newly rising pores and skin fungus that’s extremely contagious and immune to widespread antifungal therapies. Silent group unfold seemed to be behind the unconnected instances. Total, drug-resistant fungal pores and skin an infection instances (aka ringworm) have been recognized in not less than 11 US states to this point.
With resistance on the rise, researchers on the Facilities for Illness Management and Prevention took a better have a look at how US clinicians prescribe topical antifungals. As is the case of antibiotics and bacterial infections, overuse of antifungals can drive the event of resistance. And correctly diagnosing pores and skin infections will be extraordinarily troublesome with out diagnostics. A 2016 survey examine discovered that even board-certified dermatologists have been incessantly fallacious when attempting to determine pores and skin infections simply by sight.
As a primary step to assessing the scenario, the CDC researchers turned to information on prescriptions written for 48.8 million Medicare Half D beneficiaries in 2021. In the entire 12 months, clinicians prescribed 6.5 million topical antifungal therapies. That is sufficient prescriptions for about one out of each eight Medicare Half D beneficiaries to get an antifungal.
Among the many whole dataset of Medicare prescribers, there have been a little bit over one million prescribing clinicians, however solely about 131,000 of these clinicians prescribed topical antifungals. When these prescribers have been ranked by the quantity of antifungal therapies they prescribed, the highest 10 p.c—13,106 prescribers—accounted for about 45 p.c of all of the antifungal prescriptions written that 12 months, or 2.9 million of the overall 6.5 million.
Problematic prescribers
Many of the 12 months’s matters antifungal prescriptions have been written by main care physicians, who wrote about 40 p.c of the prescriptions. They have been adopted by nurse practitioners/doctor assistants, dermatologists, and podiatrists.
The commonest prescriptions have been for ketoconazole, nystatin, and clotrimazole-betamethasone dipropionate, a mix medication containing an antifungal and a corticosteroid. The latter is especially regarding because the mixture is considered a driver of drug resistance.
Whereas the info factors to some suppliers probably overprescribing antifungal medicines—and a few antifungal medicines which are notably liable to driving resistance—the researchers did not have diagnostic information on the instances. Thus, they could not inform what number of antifungal prescriptions have been backed up by diagnostic testing confirming a fungal an infection. That stated, one other limitation of the examine is that it did not seize the usage of over-the-counter antifungal medicines. Due to this fact, the usage of antifungals amongst Medicare beneficiaries is probably going underestimated.
The examine is a preliminary step to enhancing antifungal stewardship, the authors notice. However “The substantial quantity of topical antifungal and antifungal-corticosteroid prescriptions amongst Medicare Half D beneficiaries within the setting of rising resistant infections underscores the necessity to consider present practices of topical antifungal use,” the authors conclude. Clinicians ought to “be even handed,” they warning, and make sure fungal pores and skin an infection diagnoses when potential.
