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U.S. antifungal prescribing patterns likely driving antimicrobial resistance

Dermatophytosis, photo by Asurnipal via Wikimedia Commons

The Morbidity and Mortality Weekly Report (MMWR) published by the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention on Jan. 11, 2024, revealed concerning findings about the prescribing patterns of topical antifungal medications for Medicare Part D beneficiaries in the United States in 2021, and what those patterns mean for the spread of antimicrobial-resistant strains of infectious fungi.

The report highlighted that approximately 6.5 million topical antifungal prescriptions, costing US$231 million, were filled for Medicare Part D patients in 2021, which translates to approximately one prescription for every eight beneficiaries, and 10% of antifungal prescribers prescribed nearly one-half of these medications. Most of these prescriptions were written by primary care physicians, nurse practitioners, or physician assistants, rather than dermatologists. The report emphasized the need to better understand current prescribing practices to encourage judicious prescribing by clinicians and improve patient education about recommended use, especially in the context of emerging antimicrobial resistance.

This report also pointed out the potential implications for public health, stating that “incorrect use of topical antifungals and antifungal-corticosteroid combinations is likely contributing to the global emergence and spread of severe antimicrobial-resistant superficial fungal infections, which have recently been detected in the United States.”

Findings in the report are based on an analysis of publicly available U.S. Centers for Medicare & Medicaid Services (CMS) data. The report also highlighted that understanding prescribing patterns, including identifying clinicians who prescribe a disproportionate volume of topical antifungals, might help establish and promote the correct use of these medications.


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