Over Half of Topical Antifungal Rxs May Be Unnecessary

TOPLINE:

More than half of the topical antifungal prescriptions in the United States in 2023 may have been unnecessary, and only 16% of patients received diagnostic testing to confirm the need for these prescriptions, according to a study using an insurance claims database.

METHODOLOGY:

• Researchers analyzed data from Merative MarketScan Commercial and Medicare databases to identify outpatients prescribed topical antifungals in 2023, encompassing approximately 15.7 million individuals.
• Prescriptions were categorized as potentially unnecessary if not associated with a fungal infection diagnosis or diagnostic testing.
• Highest prescribing rates (per 1000 outpatients) were seen among patients aged ≥ 65 years (73.4), women (40.4), and those living in the Northeast (45.0) and for antifungals ketoconazole (10.2) and clotrimazole-betamethasone (7.3).

TAKEAWAY:

• Among 568,715 outpatients prescribed topical antifungals, 51.6% were classified as potentially unnecessary. Only 16% of patients prescribed a topical antifungal received diagnostic testing.
• The highest rates of unnecessary prescribing were observed for combination antifungal-corticosteroids, such as clotrimazole-betamethasone (73.0%) and nystatin-triamcinolone (60.3%).
• Potentially unnecessary prescribing was lowest among podiatrists (16.4%) and dermatologists (26.0%) but highest among primary care physicians (49.5%), pediatricians (52.5%), and other or unknown specialty types (73.5%).
• Over 50% of prescriptions for polyenes, clotrimazole-betamethasone, and nystatin-triamcinolone by dermatologists were potentially unnecessary.

IN PRACTICE:

“Our study found that a substantial proportion of topical antifungal prescriptions were not associated with a fungal diagnosis or diagnostic testing, highlighting potential opportunities to improve clinical practice in an era of emerging antifungal-resistant fungal skin infections,” the authors wrote.

SOURCE:

The study was led by Jeremy A. W. Gold, MD, MS, of the Mycotic Diseases Branch,Centers for Disease Control and Prevention, Atlanta, Georgia. It was published online on January 19 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

Information on over-the-counter topical antifungals, patient adherence, treatment outcomes, and testing results was not available. Additionally, researchers noted the absence of data from non-commercially insured populations, as well as potential undercoding and disease misclassification.

DISCLOSURES:

The study did not receive any funding. One author disclosed receiving research funding from Moberg Pharmaceuticals and Belle Torus Corporation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.