January 11, 2024
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Key takeaways:
- Antimicrobial resistance in superficial fungal infections is on the rise.
- Almost half of prescriptions for topical antifungals in the U.S. are written by just 10% of prescribers.
The CDC on Thursday urged physicians to be judicious in prescribing topical antifungals in light of the recent detection of antimicrobial-resistant superficial fungal infections in the United States.
The warning accompanied new findings from a CDC review of topical antifungal prescriptions filled by Medicare Part D beneficiaries in 2021, which found that nearly half of the more than 6 million prescriptions were written by just 10% of prescribers.
Data derived from Benedict K, et al. MMWR Morb Mortal Wkly Rep. 2023;doi:10.15585/mmwr.mm7301a1.
Commenting on the findings, the CDC encouraged providers — whenever possible — to confirm a fungal diagnosis before prescribing topical antifungals.
“The large volume of topical antifungal prescriptions and the rise of emerging resistant fungal skin infections worldwide highlight the need to evaluate current practices,” the CDC said in a summary of the findings sent to reporters. “Clinicians should confirm suspected fungal skin infections whenever possible before prescribing and educate patients about appropriate use.”
The authors of the new study highlighted the emergence of antimicrobial-resistant dermatophytosis — also known as ringworm or tinea — in at least 11 U.S. states and noted that large outbreaks of resistant skin infections have been reported throughout South Asia.
For the study, they reviewed data from around 48.8 Medicare Part D beneficiaries to determine the volume, rate and cost of topical antifungal prescriptions filled in 2021.
The records showed that Part D beneficiaries filled 6.5 million prescriptions for topical antifungals that year — approximately one prescription for every eight beneficiaries — at a cost of $231 million, although the authors noted that the actual volume is likely much higher because most topical antifungals can be purchased over the counter.
“Such topical antifungal use is not recorded in CMS data and is an important consideration for potential antifungal stewardship efforts,” they wrote in MMWR.
The most commonly prescribed antifungals were ketoconazole (2.4 million prescriptions), nystatin (1.9 million) and clotrimazole-betamethasone dipropionate (0.9 million), and the most expensive antifungal was efinaconazole at $1,035 per prescription, according to the study.
Primary care physicians prescribed 40% of topical antifungals — 2.6 million prescriptions overall — but ranked third among all specialties with 12.3 prescriptions written per provider. Dermatologists had the highest rate of prescribing topical antifungals at 87.1 prescriptions written per provider, followed by podiatrists (67.2).
Out of all 6.5 million prescriptions for topical antifungals, around 44% were written by the top 10% of prescribers.
“To help control the emergence and spread of antimicrobial-resistant superficial fungal infections and help promote the appropriateness of topical antifungal prescribing, health care providers could use diagnostic testing whenever possible to confirm” these diagnoses, the authors of the MMWR report wrote.
“Further, health care providers can educate patients about prognosis, benefits, and harms of topical antifungal and combination antifungal-corticosteroid treatment (both prescription and over-the-counter), and the importance of using these medications as prescribed or according to manufacturer instructions,” they wrote.
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