by The excessive use of antifungal creams prescribed by doctors in the United States is believed to be contributing to the rise of drug-resistant infections, according to new research. Recent findings have identified severe antimicrobial-resistant superficial fungal infections in the country, particularly drug-resistant forms of ringworm. Outbreaks of this stubborn, circular rash have been reported in Southeast Asia, where traditional antifungal creams and pills have proven ineffective. Alarmingly, cases of drug-resistant ringworm have also been discovered in 11 U.S. states, resulting in extensive lesions and delayed diagnosis.
Similar to the overuse of antibiotics, fungi can develop resistance to antifungal medications with increased exposure. The study conducted by researchers from the U.S. Centers for Disease Control and Prevention (CDC) suggests that antifungal topical creams are being overly prescribed. Analysis of 2021 Medicare Part D data revealed that approximately 6.5 million prescriptions for antifungal creams, containing substances such as ketoconazole, nystatin, and clotrimazole-betamethasone, were issued that year. The study, published in the CDC journal Morbidity and Mortality Weekly Report on January 11, highlighted that while primary care physicians wrote the highest percentage of these prescriptions, dermatologists and podiatrists had significantly higher prescription rates per doctor.
One of the primary concerns identified by the CDC team is the reliance on visual diagnosis by most doctors. Even board-certified dermatologists frequently misdiagnose skin conditions based solely on appearance. Confirmatory diagnostic testing of skin lesions beyond visual assessment is rarely conducted. The study also revealed that a small percentage of physicians prescribe antifungal drugs at alarmingly high rates, with 10% of antifungal prescribers accounting for almost half of all prescriptions in 2021. It is important to note that the study likely underestimates the extent of antifungal overuse, as many topical antifungal creams are available over the counter without a prescription.
The high utilization of clotrimazole-betamethasone, in particular, has been identified as a significant factor in the emergence of drug-resistant ringworm. This medication, which combines a steroid with an antifungal, can potentially cause skin damage if applied to intertriginous areas where the skin folds, such as the groin, buttocks, and armpits. Prolonged and extensive usage of clotrimazole-betamethasone can also lead to hormonal issues, further emphasizing the dangers associated with its misuse.
The CDC team emphasizes the need for healthcare providers to exercise caution when prescribing topical antifungals for suspected fungal skin infections. They recommend going beyond visual diagnosis whenever possible and conducting further diagnostic tests. Additionally, doctors should educate patients on the proper use of topical antifungal creams and combination antifungal-corticosteroids to reduce overprescribing and the risk of drug-resistant fungal infections.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
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