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Doctors in the US are prescribing antifungal creams at rates so high they could be contributing to the rise of drug-resistant infections, a new federal report shows.

These are “severe antimicrobial-resistant superficial fungal infections, which have recently been detected in the United States,” authors of a Morbidity and Mortality Weekly Report said in January.

Among the biggest threats are drug-resistant forms of ringworm, which have surfaced in 11 states. Like bacteria, fungi can build up a resistance to antifungal medications if the fungi are exposed to them often.

The report said antifungal topical creams are being overprescribed by clinicians including primary care physicians and podiatrists. Multidrug-resistant organisms pose a significant threat to nursing home residents who often live in close quarters and have weakened immune systems.

The report suggested doctors use lab tests to supplement visual diagnoses and ensure the correct medications are being prescribed.