{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:41:45Z","timestamp":1791906105569,"version":"4.3.4"},"reference-count":18,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T00:00:00Z","timestamp":1640131200000},"content-version":"unspecified","delay-in-days":355,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S2732494X21002011_as1\">\n\t    <jats:title>Background:<\/jats:title>\n\t    <jats:p>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.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X21002011_as2\">\n\t    <jats:title>Objective:<\/jats:title>\n\t    <jats:p>We analyzed outpatient antifungal prescribing data in the United States to inform stewardship efforts.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X21002011_as3\">\n\t    <jats:title>Design:<\/jats:title>\n\t    <jats:p>Descriptive analysis of outpatient antifungal prescriptions dispensed during 2018 in the IQVIA Xponent database.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X21002011_as4\">\n\t    <jats:title>Methods:<\/jats:title>\n\t    <jats:p>Prescriptions were summarized by drug, sex, age, geography, and healthcare provider specialty. Census denominators were used to calculate prescribing rates among demographic groups.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X21002011_as5\">\n\t    <jats:title>Results:<\/jats:title>\n\t    <jats:p>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).<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X21002011_as6\">\n\t    <jats:title>Conclusions:<\/jats:title>\n\t    <jats:p>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.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/ash.2021.201","type":"journal-article","created":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T06:05:43Z","timestamp":1640153143000},"source":"Crossref","is-referenced-by-count":19,"title":["Outpatient antifungal prescribing patterns in the United States, 2018"],"prefix":"10.1017","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0458-2493","authenticated-orcid":false,"given":"Kaitlin","family":"Benedict","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon V.","family":"Tsay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monina G.","family":"Bartoces","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Snigdha","family":"Vallabhaneni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan R.","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauri A.","family":"Hicks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2021,12,22]]},"reference":[{"key":"S2732494X21002011_ref4","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3410-4"},{"key":"S2732494X21002011_ref8","unstructured":"8. Bridged-race population estimates, 1990\u20132018. Centers for Disease Control and Prevention website. http:\/\/wonder.cdc.gov\/bridged-race-v2018.html. Published 2018. Accessed January 9, 2020."},{"key":"S2732494X21002011_ref13","unstructured":"13. Vulvovaginal candidiasis. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/std\/treatment-guidelines\/candidiasis.htm. Published 2021. Accessed October 18, 2021."},{"key":"S2732494X21002011_ref16","unstructured":"16. FDA Drug Safety Communication: FDA warns that prescribing of nizoral (ketoconazole) oral tablets for unapproved uses including skin and nail infections continues; linked to patient death. US Food and Drug Administration website. https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-drug-safety-communication-fda-warns-prescribing-nizoral-ketoconazole-oral-tablets-unapproved. Accessed October 4, 2021."},{"key":"S2732494X21002011_ref5","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp160943"},{"key":"S2732494X21002011_ref2","doi-asserted-by":"publisher","DOI":"10.1289\/EHP7484"},{"key":"S2732494X21002011_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2018.05.1260"},{"key":"S2732494X21002011_ref15","doi-asserted-by":"publisher","DOI":"10.3390\/jof4040121"},{"key":"S2732494X21002011_ref10","unstructured":"10. Burden of fungal diseases in the United States. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/fungal\/cdc-and-fungal\/burden.html. Accessed December 8, 2020."},{"key":"S2732494X21002011_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dky270"},{"key":"S2732494X21002011_ref11","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2002.8.6.499"},{"key":"S2732494X21002011_ref12","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6874-14-43"},{"key":"S2732494X21002011_ref9","unstructured":"9. Outpatient antibiotic prescriptions\u2014United States, 2018. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/antibiotic-use\/data\/report-2018.html. Published 2018. Accessed July 78, 2021,"},{"key":"S2732494X21002011_ref6","first-page":"370","article-title":"Changes in US outpatient antibiotic prescriptions from 2011\u20132016","volume":"70","author":"King","year":"2020","journal-title":"Clin Infect Dis"},{"key":"S2732494X21002011_ref7","unstructured":"7. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/antibiotic-use\/community\/pdfs\/Uniform-System-of-Classification-2018-p.pdf. Published 2018. Accessed February 26, 2021."},{"key":"S2732494X21002011_ref14","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ933"},{"key":"S2732494X21002011_ref17","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4151"},{"key":"S2732494X21002011_ref1","unstructured":"1. Antibiotic resistance threats in the United States, 2019. Centers for Disease Control and Prevention website. Published 2019. https:\/\/www.cdc.gov\/drugresistance\/pdf\/threats-report\/2019-ar-threats-report-508.pdf. Accessed October 4, 2021."}],"container-title":["Antimicrobial Stewardship &amp; Healthcare Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2732494X21002011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T06:05:48Z","timestamp":1640153148000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2732494X21002011\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021]]}},"alternative-id":["S2732494X21002011"],"URL":"https:\/\/doi.org\/10.1017\/ash.2021.201","relation":{},"ISSN":["2732-494X"],"issn-type":[{"value":"2732-494X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021]]},"article-number":"e68"}}