CDC report aims to promote more appropriate topical antifungal prescribing

A global increase in severe antimicrobial-resistant fungal infections of the skin—partly due to inappropriate use of topical antifungals and antifungal-corticosteroid combinations—has found its way to the United States.

An understanding of prescribing patterns—including who is prescribing these agents with unusually high frequency—can help inform strategies to combat the trend, however.

In a new report, CDC scrutinized Medicare Part D data from 2021, finding that an estimated 6.5 million topical antifungal prescriptions were filled that year at a total cost of $231 million.

The volume was enough, study authors calculated, to provide about one prescription per every eight patients—although the numbers almost certainly are underrepresented, as most topic antifungals can be purchased OTC and therefore were not included in the Medicare study.

Within that dataset, primary care physicians wrote the most prescriptions, followed respectively by nurse practitioners or physician assistants, dermatologists, and podiatrists.

Overuse of topical antifungal agents is largely driven by inaccurate diagnosis based on physical examination only and failure to follow up suspected infections with confirmatory testing.

The authors suggest clinicians “could use diagnostic testing whenever possible to confirm suspected superficial fungal infections. 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.”