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Millions wasted on inappropriate antifungal drugs

Millions of pounds of NHS funds may be being wasted on expensive antifungal drugs because GPs often do not confirm toenail infections before prescribing, claims an infectious diseases specialist.

Dr David Denning, head of the antifungal testing laboratory at the University of Manchester, urged GPs to send all suspected toenail samples for testing to ensure the right treatment could be given.

At a meeting of the Fungal Research Trust charity in London, Dr Denning said there could be as many 2.5 million people in the UK with fungal toenail infections.

In 60 per cent of cases, GPs prescribed treatment without laboratory confirmation, despite the £536 cost of a six-month course of terbinafine.

'Treatment fails in 20 per cent of cases,' said Dr Denning. 'It could be because the fungi are not sensitive to the drug that has been prescribed or the diagnosis is wrong, or the drug for some other reason fails to work.'

He argued GPs were given insufficient training in mycology and dermatology.

But Dr Douglas Fleming, a member of the Department of Health's specialist advisory committee on antimicrobial resistance and director of the RCGP's Birmingham research unit, said he believed non-compliance was the reason a high proportion of antifungal treatments failed.

He argued that GPs tended to prescribe drugs without pre-testing because the tests could be unreliable.

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