The spread of severe skin, scalp, and nail fungal infections has become a growing concern for dermatologists and healthcare professionals worldwide. According to a report by the US Centers for Disease Control and Prevention (CDC), the use of antifungal creams and combinations with corticosteroids is believed to be contributing to the rise of these drug-resistant fungal infections. This article delves into the findings of the CDC report and examines the prescribing practices of healthcare providers.

In 2023, dermatologists in the US detected the first cases of highly contagious drug-resistant fungal skin infections that did not respond to available treatments. Initially prevalent in Southeast Asia, these infections have now spread to China and beyond, with at least 11 US states reporting cases. To gain a better understanding of the situation, researchers at the CDC analyzed a year’s worth of antifungal prescriptions in the US to identify patterns and shed light on the types of clinicians and drugs involved.

Similar to the rise of antibiotic resistance among bacteria, the overuse of antifungals can create opportunities for potentially pathogenic fungi to develop resistance. This is especially concerning when antifungals are prescribed incorrectly or misused. The CDC team, led by epidemiologist Kaitlin Benedict, aimed to address the issue by analyzing antifungal prescribing practices and providing insights to improve the situation.

Examining Prescribing Practices

The CDC researchers examined data from approximately 1 million health professionals who wrote prescriptions for nearly 49 million Medicare-covered individuals in 2021. They found that primary care physicians were the largest group of antifungal prescribers (40%), followed by nurse practitioners, dermatologists, and podiatrists. The data revealed that roughly 6.5 million topical antifungal prescriptions were filled in the US during that year, amounting to a total cost of $231 million.

Limitations and Potential Overuse

The CDC researchers acknowledged that their study likely underestimated the actual volume of topical antifungal use because many antifungals can be purchased over the counter without a prescription. They also noted that the Medicare data did not provide diagnostic information on the specific types of fungal infections patients had. Consequently, it was impossible to determine whether patients were receiving the appropriate medication or if doctors had conducted tests to accurately prescribe the right drug.

Concerns Over Combination Treatments

A significant concern highlighted by Benedict and her colleagues was the widespread use of clotrimazole-betamethasone, which accounted for 15% of all topical antifungal prescriptions. This combination treatment is believed to be a potential driver of emerging drug-resistant tinea, also known as dermatophytosis. The researchers emphasize the importance of diagnostic testing to confirm suspected superficial fungal infections, as relying solely on visual diagnosis can often lead to incorrect treatment.

To combat the emergence and spread of drug-resistant fungal infections, healthcare providers should prioritize diagnostic testing whenever possible. By confirming the presence of a superficial fungal infection, providers can ensure the appropriateness of topical antifungal prescribing. Additionally, increased patient education regarding the recommended use of antifungal medications is crucial to prevent misuse and reduce the chances of resistance development.

The CDC report sheds light on the concerning rise and spread of drug-resistant fungal infections. Antifungal prescribing practices play a significant role in the emergence and spread of these infections. It is essential for healthcare providers to prescribe antifungals judiciously and employ diagnostic testing to confirm infections. Through a multifaceted approach involving education, appropriate prescribing practices, and diagnostic accuracy, we can hope to control the prevalence of drug-resistant fungal infections and protect public health.

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