Antifungal Dispensing in Denmark: Patterns Across Primary Care, Secondary Care, and Over-the-Counter Sectors

Fungal infections pose a significant health burden in Denmark. Increasing global antifungal use and emerging antifungal resistance underscore the need for ongoing characterization of national prescribing trends to inform antifungal stewardship. Danish Health Data Bank Medstat site was accessed to assess total antifungal dispensing in Denmark from 1996 to 2025 across primary care, secondary care (hospitals), and over-the-counter sectors for both topical and systemic antifungals. Over the 30-year period, national antifungal dispensing patterns shifted substantially, with increased dispensing of azole/corticosteroid combination products in primary care (mean annual change of 0.065 g or ml per 1000 inhabitants/day), and persistent predominance of miconazole in secondary care and over-the-counter settings. Systemic prescribing was dominated by oral terbinafine in primary care and fluconazole in secondary care. Oral terbinafine dispensing in primary care was highest in 2009, while fluconazole dispensing peaked in 2013 in secondary care. Following peaks between 2009 and 2013, dispensing of several systemic antifungals subsequently declined, suggesting evolving prescribing patterns over time. Continued increases in azole/corticosteroid dispensing raises concerns regarding antifungal stewardship. Shifts in systemic antifungal dispensing for terbinafine and fluconazole may reflect changes in demographics, disease incidence (e.g., cancer), treatment guidelines, and clinical practice.