Over half of Topical Antifungal prescriptions in the U.S. May Be Unnecessary, Study Finds
In 2023, more than half of the topical antifungal prescriptions in the United states may have been unnecessary, according to a recent study. The research, which analyzed data from insurance claims databases, revealed that onyl 16% of patients received diagnostic testing to confirm the need for these medications.This raises concerns about overprescribing and its implications for antifungal resistance.
The Study’s Methodology
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Researchers examined data from the merative MarketScan Commercial and Medicare databases, covering approximately 15.7 million individuals. They identified outpatients prescribed topical antifungals and categorized prescriptions as potentially unnecessary if they lacked a fungal infection diagnosis or diagnostic testing. the highest prescribing rates were observed among patients aged 65 and older (73.4 per 1,000 outpatients), women (40.4), and those living in the Northeast (45.0). The most commonly prescribed antifungals were ketoconazole (10.2) and clotrimazole-betamethasone (7.3).
Key findings
The study analyzed 568,715 outpatients prescribed topical antifungals and found that 51.6% of these prescriptions were potentially unnecessary. Diagnostic testing was conducted in only 16% of cases.The highest rates of unnecessary prescribing were seen for combination antifungal-corticosteroids, such as clotrimazole-betamethasone (73.0%) and nystatin-triamcinolone (60.3%).
Specialty-specific data revealed that podiatrists (16.4%) and dermatologists (26.0%) had the lowest rates of potentially unnecessary prescribing. In contrast, primary care physicians (49.5%), pediatricians (52.5%), and other or unknown specialty types (73.5%) had the highest rates.Notably, over 50% of prescriptions for polyenes, clotrimazole-betamethasone, and nystatin-triamcinolone by dermatologists were classified as potentially unnecessary.
Implications for Clinical Practice
The study’s authors emphasized the need for improved clinical practices, notably in light of emerging antifungal-resistant fungal skin infections. “Our study found that a considerable proportion of topical antifungal prescriptions were not associated with a fungal diagnosis or diagnostic testing, highlighting potential opportunities to improve clinical practice,” they wrote.
Limitations and Considerations
The study had several limitations, including the lack of data on over-the-counter topical antifungals, patient adherence, treatment outcomes, and testing results. Additionally,the absence of data from non-commercially insured populations and potential undercoding or disease misclassification may have affected the findings.
Summary of Key Findings
| Category | Details |
|———————————–|—————————————————————————–|
| Unnecessary Prescriptions | 51.6% of topical antifungal prescriptions were potentially unnecessary. |
| Diagnostic Testing | Only 16% of patients received diagnostic testing. |
| Highest Unnecessary Rates | Clotrimazole-betamethasone (73.0%), nystatin-triamcinolone (60.3%). |
| Specialty-Specific Rates | Podiatrists (16.4%), dermatologists (26.0%), primary care physicians (49.5%).|
The study, lead by Jeremy A. W. Gold, MD, MS, of the Mycotic Diseases Branch at the Centers for Disease Control and Prevention, was published online on January 19 in the Journal of the American Academy of Dermatology.
this research underscores the importance of diagnostic testing and evidence-based prescribing to curb unnecessary use of topical antifungals and mitigate the risk of antifungal resistance.
Headline: “Unnecessary Topical Antifungal Prescriptions: A Growing Concern – An Interview with Dr. Laura Miller”
Introduction: Join us as we discuss a recent study that sheds light on the concerning trend of unnecessary topical antifungal prescriptions in the United States. Dr. Laura Miller, a renowned infectious disease specialist, shares her insights on the potential implications for antifungal resistance and offers recommendations for improving prescription practices.
The Study’s methodology
Senior Editor (SE): Dr. Miller, can you tell our readers a bit about the methodology of this study?
Dr. Laura Miller (DLM): Certainly! The study examined data from the Merative MarketScan Commercial and Medicare databases, encompassing around 15.7 million individuals. Researchers identified outpatients prescribed topical antifungals and categorized prescriptions as potentially unnecessary if they lacked a fungal infection diagnosis or diagnostic testing.they also analyzed prescription rates based on factors like age, gender, and geographic location, revealing higher rates among older adults, women, and those in the Northeast. Some of the most commonly prescribed antifungals where ketoconazole and clotrimazole-betamethasone.
Key Findings
SE: The study found that over half of these prescriptions might be unnecessary. Can you elaborate on this finding?
DLM: Indeed, the study analyzed 568,715 outpatients prescribed topical antifungals and found that 51.6% of these prescriptions were potentially unnecessary.Only 16% of patients received diagnostic testing, which is concerning. We also saw higher rates of unnecessary prescribing for combination antifungal-corticosteroids like clotrimazole-betamethasone and nystatin-triamcinolone. Specialty-specific data showed that primary care physicians, pediatricians, and others had the highest rates of potential overprescribing.
Implications for Clinical Practice
SE: How do these findings impact clinical practice, and what recommendations do the authors make?
DLM: These findings emphasize the need for improved clinical practices, especially given the emergence of antifungal-resistant fungal skin infections.The authors stress the importance of diagnostic testing and evidence-based prescribing to curb unnecessary use and mitigate the risk of antifungal resistance. They suggest that dermatologists and other prescribers should follow established guidelines and consider option treatments when appropriate.
Limitations and Considerations
SE: While informative, the study has certain limitations.Could you discuss them briefly?
DLM: Yes, some of the study’s limitations include the lack of data on over-the-counter topical antifungals, patient adherence, treatment outcomes, and testing results. Additionally, the absence of data from non-commercially insured populations and potential undercoding or disease misclassification may have affected the findings. Therefore, we should interpret the results with these factors in mind and continue to monitor this situation.
Summary of Key Findings
SE: Dr. Miller, could you give us a concise summary of the key findings?
DLM: Certainly! Over half of topical antifungal prescriptions in the U.S. may be unnecessary, with only 16% accompanied by diagnostic testing. High rates of unnecessary prescribing were seen for combination antifungal-corticosteroids. Primary care physicians, pediatricians, and others had the highest rates of potential overprescribing, while podiatrists and dermatologists had lower rates. The study underscores the importance of diagnostic testing and evidence-based prescribing to address this issue and prevent antifungal resistance.
SE: Thank you,Dr. Miller, for sharing your expert insights on this critical topic.
DLM: My pleasure. It’s important to raise awareness about this issue and encourage improvements in clinical practice.
