Outpatient antifungal prescribing patterns in the United States, 2018
Abstract 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 antifungal agents. Objective: We analyz...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2021-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X21002011/type/journal_article |
| _version_ | 1811157249063649280 |
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| author | Kaitlin Benedict Sharon V. Tsay Monina G. Bartoces Snigdha Vallabhaneni Brendan R. Jackson Lauri A. Hicks |
| author_facet | Kaitlin Benedict Sharon V. Tsay Monina G. Bartoces Snigdha Vallabhaneni Brendan R. Jackson Lauri A. Hicks |
| author_sort | Kaitlin Benedict |
| collection | DOAJ |
| description |
Abstract
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 antifungal agents.
Objective:
We analyzed outpatient antifungal prescribing data in the United States 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 commonly prescribed drug (75%), followed by terbinafine (11%) and nystatin (10%). Prescription rates were higher among females versus males (110 vs 25 per 1,000 population) and adults versus children (82 vs 27 per 1,000 population). Prescription rates were highest in the South (81 per 1,000 population) and lowest in the West (48 per 1,000 population). 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 antifungal drugs in the outpatient setting is common, with enough courses dispensed for 1 in every 15 US 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.
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| first_indexed | 2024-04-10T05:04:02Z |
| format | Article |
| id | doaj.art-b786b00b9210416aba9e12ee737cb961 |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-04-10T05:04:02Z |
| publishDate | 2021-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-b786b00b9210416aba9e12ee737cb9612023-03-09T12:27:47ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2021-01-01110.1017/ash.2021.201Outpatient antifungal prescribing patterns in the United States, 2018Kaitlin Benedict0https://orcid.org/0000-0003-0458-2493Sharon V. Tsay1Monina G. Bartoces2Snigdha Vallabhaneni3Brendan R. Jackson4Lauri A. Hicks5Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GeorgiaDivision of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GeorgiaDivision of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GeorgiaMycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GeorgiaMycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GeorgiaDivision of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Abstract 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 antifungal agents. Objective: We analyzed outpatient antifungal prescribing data in the United States 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 commonly prescribed drug (75%), followed by terbinafine (11%) and nystatin (10%). Prescription rates were higher among females versus males (110 vs 25 per 1,000 population) and adults versus children (82 vs 27 per 1,000 population). Prescription rates were highest in the South (81 per 1,000 population) and lowest in the West (48 per 1,000 population). 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 antifungal drugs in the outpatient setting is common, with enough courses dispensed for 1 in every 15 US 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. https://www.cambridge.org/core/product/identifier/S2732494X21002011/type/journal_article |
| spellingShingle | Kaitlin Benedict Sharon V. Tsay Monina G. Bartoces Snigdha Vallabhaneni Brendan R. Jackson Lauri A. Hicks Outpatient antifungal prescribing patterns in the United States, 2018 Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Outpatient antifungal prescribing patterns in the United States, 2018 |
| title_full | Outpatient antifungal prescribing patterns in the United States, 2018 |
| title_fullStr | Outpatient antifungal prescribing patterns in the United States, 2018 |
| title_full_unstemmed | Outpatient antifungal prescribing patterns in the United States, 2018 |
| title_short | Outpatient antifungal prescribing patterns in the United States, 2018 |
| title_sort | outpatient antifungal prescribing patterns in the united states 2018 |
| url | https://www.cambridge.org/core/product/identifier/S2732494X21002011/type/journal_article |
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