Better Testing for Fungal Infections Avoids Antibiotic Misuse

January 30th, 2017

GENEVA, SWITZERLAND – Here’s a novel approach to decreasing unnecessary antibiotic use: better diagnosis of fungal infections that don’t respond to the drugs.

The report in the national Centers for Disease Control and Prevention’s Emerging Infectious Diseases journal points out how lack of proper testing for fungal infections leads to over-prescription of antibiotics worldwide.

“Inadequate attention is paid to fungal infection as the cause of antibacterial treatment failure,” write the authors, members of the Global Action Fund for Fungal Infections (GAFFI).

Antibiotic resistance is linked to 23,000 deaths per year and nearly $25 billion in excess healthcare costs in the United States, according to the article, and CDC has launched a $160 million, 50-state initiative to combat antibiotic-resistant bacteria.

This report suggests that detecting fungal infections would help, citing four common clinical situations in which a lack of routine diagnostic testing for fungal diseases often worsens the problem:

• Many people diagnosed with tuberculosis (TB) of the lungs don’t have TB – known as smear-negative cases – but are treated ineffectively with costly TB drugs. A simple antibody test can pick up the fungus Aspergillus, which can be treated by antifungal drugs rather than unnecessary anti-TB antibiotics. In 2013, more than 2.7 million smear-negative TB cases were reported to the World Health Organization.
• Inaccurate diagnosis of fungal sepsis in hospitals and intensive care units results in inappropriate use of broad-spectrum antibacterial drugs in patients with invasive candidiasis, fungal infections caused by yeasts.
• Fungal asthma often is misdiagnosed as chronic obstructive pulmonary disease and treated with antibacterial drugs and steroids. Of more than 200 million asthma sufferers, an estimated 6 million to 15 million have fungal asthma, which can be diagnosed with skin testing or blood tests and responds to antifungal agents, not antibiotics, the report notes.
• Overtreatment and undertreatment of Pneumocystis pneumonia (PCP) in HIV-positive patients also is a problem. The report estimates 400,000 patients with PCP go undiagnosed, while more than 2 million mistakenly receive unnecessary therapy.

“If we’re trying to deliver globally on a comprehensive plan to prevent antimicrobial resistance, and we’re treating blindly for fungal infections that we don’t know are present with antibiotics, then we may inadvertently be creating greater antibiotic resistance,” explained David Perlin, PhD, a lead author and executive director of Rutgers New Jersey Medical School’s Public Health Research Institute.

Perlin maintained that inexpensive, rapid diagnostic tests are available for important fungal infections but are not being used widely. He urged more training to encourage healthcare practitioners to test for fungal infections so the correct drugs are administered.

In 2013, GAFFI launched an effort to promote global awareness of fungal disease as a major cause of deaths worldwide.