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Published on: December 28, 2017
Outpatient Antifungal Prescribing Patterns in the United States, 2018
Kaitlin Benedict1, Sharon V Tsay2, Monina G Bartoces2
1Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Background:
Widespread inappropriate antibiotic prescribing is a major driver of resistance. Little is known about antifungal prescribing practices in the United States, which is concerning given emerging resistance in fungi, particularly to azole antifungals.
Objective:
We analyzed outpatient U.S. antifungal prescribing data to inform stewardship efforts.
Design:
Descriptive analysis of outpatient antifungal prescriptions dispensed during 2018 in the IQVIA Xponent database.
Methods:
Prescriptions were summarized by drug, sex, age, geography, and healthcare provider specialty. Census denominators were used to calculate prescribing rates among demographic groups.
Results:
Healthcare providers prescribed 22.4 million antifungal courses in 2018 (68 prescriptions per 1,000 persons). Fluconazole was the most common drug (75%), followed by terbinafine (11%) and nystatin (10%). Prescription rates were higher among females vs. males (110 vs. 25 per 1,000) and adults vs. children (82 vs. 27 per 1,000). Prescription rates were highest in the South (81 per 1,000 persons) and lowest in the West (48 per 1,000 persons). Nurse practitioners and family practitioners prescribed the most antifungals (43% of all prescriptions), but the highest prescribing rates were among obstetrician-gynecologists (84 per provider).
Conclusions:
Prescribing of antifungal drugs in the outpatient setting was common, with enough courses dispensed for one in every 15 U.S. residents in 2018. Fluconazole use patterns suggest vulvovaginal candidiasis as a common indication. Regional prescribing differences could reflect inappropriate use or variations in disease burden. Further study of higher antifungal use in the South could help target antifungal stewardship practices.
Insights
Antifungal drug prescriptions in the U.S. were common in 2018, with fluconazole being the most prescribed. Higher prescribing rates were observed in females, adults, and the Southern U.S. region, indicating potential areas for stewardship focus.
Area of Science:
- Pharmacology
- Infectious Diseases
- Public Health
Background:
- Inappropriate antibiotic prescribing is a major driver of antimicrobial resistance.
- Antifungal prescribing practices in the U.S. are not well understood, despite emerging fungal resistance, particularly to azoles.
Purpose of the Study:
- To analyze outpatient U.S. antifungal prescribing data.
- To inform antifungal stewardship efforts.
Main Methods:
- Descriptive analysis of outpatient antifungal prescriptions dispensed in 2018 using the IQVIA Xponent database.
- Prescriptions were summarized by drug, sex, age, geography, and healthcare provider specialty.
- Prescribing rates were calculated using census denominators.
Main Results:
- 22.4 million antifungal courses were prescribed in 2018 (68 per 1,000 persons).
- Fluconazole (75%), terbinafine (11%), and nystatin (10%) were the most common antifungals.
- Prescribing rates were higher in females (110/1000) vs. males (25/1000), adults (82/1000) vs. children (27/1000), and in the South (81/1000) vs. West (48/1000).
Conclusions:
- Outpatient antifungal drug prescribing was common, with one course dispensed for every 15 U.S. residents in 2018.
- Fluconazole use suggests vulvovaginal candidiasis as a frequent indication.
- Regional prescribing disparities and high rates in certain specialties warrant further investigation for targeted antifungal stewardship.
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