Doctors in the United States are prescribing antifungal creams at rates so high they could be contributing to the rise of drug-resistant infections, new research shows.
A new report is sounding the alarm on the increased rate of antifungal cream prescriptions, saying that the creams could be contributing to the increase of drug-resistant infections.
These are “severe antimicrobial-resistant superficial fungal infections, which have recently been detected in the United States,” authors of a report in the Jan. 11 issue of the CDC’s Morbidity and Mortality Weekly Report.
Jeremy Gold, MD, a researcher at the US Centers for Disease Control and Prevention (CDC), said one of the biggest threats is drug-resistant forms of ringworm (a form of dermatophytosis).
Experts have seen outbreaks of the rash in Southeast Asia that aren’t responding to topical antifungal creams or pills. Cases of resistant ringworm have popped up in 11 US states, Gold noted. This causes extensive lesions and delays in diagnosis, the report stated.
Like bacteria, fungi can build up a resistance to antifungal medications if the fungi are exposed to them a lot. The CDC report said the antifungal topical creams are being overprescribed by clinicians. Multidrug-resistant organisms pose a significant threat to nursing home residents who often live in close quarters and have weakened immune systems.
The team examed Medicare Part D data from 2021 and noted there were 6.5 million prescriptions for creams containing antifungals (like ketoconazole, nystatin and clotrimazole-betamethasone) prescribed that year. Primary care doctors wrote most of the prescriptions, but dermatologists and podiatrists had higher rates on a prescriptions-per-doctor basis. That year, 10% of antifungal prescribers gave out about half of all the medications, the team found.
Doctors need to make an accurate diagnosis, and not write out prescriptions for ailments unless they’re sure about what it is. Many clinicians make a diagnosis visually, when they could be doing lab tests to confirm it, the authors noted.
In addition to being overprescribed, the creams are being overused as many antifungal creams are available over the counter.
The popularity of Lotrisone (clotrimazole-betamethasone) is particularly thought to be a big factor in the emergence of drug-resistant ringworm. The drug can damage skin if it’s applied to areas of skin that fold, such as the groin or armpits. Using the drug in the long term can drive hormonal problems as well, according to the report.
“Healthcare providers should be judicious in prescribing topical antifungals” for suspected fungal skin infections, and go beyond a visual diagnosis when possible, the team wrote.
