CDC urges clinicians to confirm fungal infections before prescribing antifungal medications.

CDC urges clinicians to confirm fungal infections before prescribing antifungal medications.

Clinicians in the US may be overprescribing topical antifungal treatments for skin infections, potentially exacerbating a growing problem of drug resistance, according to a new study.

Last year, a dermatologist in New York reported the country’s first cases of a newly emerging skin fungus that is highly contagious and resistant to common antifungal treatments. Silent community spread appeared to be behind the unconnected cases. Overall, drug-resistant fungal skin infection cases (aka ringworm) have been identified in at least 11 US states to date.

With resistance on the rise, researchers at the Centers for Disease Control and Prevention took a closer look at how US clinicians prescribe topical antifungals. As is the case of antibiotics and bacterial infections, overuse of antifungals can drive the development of resistance. And properly diagnosing skin infections can be extremely difficult without diagnostics. A 2016 survey study found that even board-certified dermatologists were frequently wrong when trying to identify skin infections just by sight.

  • Apathy TreeEnglish
    7•8 months ago

    I had a case of ringworm from a public hot tub that topicals wouldn’t touch (it kept spreading, and most of the spots wouldn’t clear up… I had probably 15 identifiable spots, and a bunch more “maybe?” spots.)

    I went to urgent care to get a prescription anti fungal pill, and the doc said it definitely wasn’t ringworm, but eczema… why? Because the spots weren’t round and weren’t really red either. It was an atypical presentation.

    I pushed back on his bullshit not-listening-to-the-patient diagnosis, after all, if he was right, it would have been an atypical presentation of eczema, which isn’t more likely than atypical ringworm (no itching, no history, just suddenly dozens of spots all over the body? Yeah, sounds super likely…), and with it spreading, and having infected my partner as well (topical treatment was sufficient for them), which I had told him about, why take the risk, right? Told him I wasn’t leaving without the prescription or a second opinion, because he was wrong. He finally relented, but wasn’t happy.

    Well I was right, the anti fungal cleared it right up, so fuck that guy. But when doctors don’t listen to patients, and don’t run any tests at all, just eyeball the infection and send you on your way, you end up exposing the pathogens to the weaker OTC stuff for longer and exacerbate the resistance problem. Plus spreading it to other humans/animals, which can exponentially increase the problem.

    The long and short of this is testing should be routine for anything potentially infectious, and mandatory, to make sure illness is treated the right way the first time, without the patient having to argue or demand a second opinion. Healthcare providers are lazy as hell when it comes to diagnosing (“I think you have xyz, which we could test for to verify but won’t, take this med and come back if it doesn’t work over the next 2 weeks.”), and that really needs to change.