A new disease is popping up.
Recent research highlights a concerning trend in the United States where doctors’ high prescription rates of antifungal creams may be contributing to the increasing prevalence of drug-resistant infections. Led by Jeremy Gold from the U.S. Centers for Disease Control and Prevention, the study reveals the emergence of severe antimicrobial-resistant superficial fungal infections in the country, with a specific concern about the rise of drug-resistant forms of ringworm in 11 U.S. states, causing extensive lesions and delayed diagnoses.
The study suggests that the overuse of antifungal topical creams, akin to the overprescription of antibiotics, is a contributing factor to the development of resistance. Analysis of 2021 Medicare Part D data indicates that 6.5 million prescriptions for creams containing antifungals were issued that year, with primary care doctors responsible for the highest number of prescriptions. Dermatologists and podiatrists, however, exhibited significantly higher rates per doctor. The study underscores a critical issue where doctors, even board-certified dermatologists, often rely on inaccurate visual diagnoses, and confirmatory diagnostic testing for skin lesions is infrequently performed.
A noteworthy discovery is that a small percentage of physicians are prescribing antifungal drugs at exceptionally high rates, with 10% of antifungal prescribers accounting for nearly half of these medications in 2021. The study acknowledges the likelihood of underestimating overall antifungal overuse, considering the availability of many topical antifungals over the counter without a prescription. The excessive use of clotrimazole-betamethasone, a combination of a steroid and an antifungal, is identified as a significant factor in the emergence of drug-resistant ringworm, causing skin damage and potential hormonal problems with prolonged use.
In response to these findings, the CDC team advises healthcare providers to exercise caution when prescribing topical antifungals for suspected fungal skin infections. They stress the importance of moving beyond visual diagnoses whenever possible and educating patients about the correct usage of topical antifungals and combination antifungal-corticosteroids to mitigate overprescribing and the associated risk of drug-resistant fungal diseases.
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