GPs have been urged to delay anti-fungal treatment until they have laboratory results on infections, and encourage more self-care, by Health Protection Agency researchers.
The guidance comes after a survey of 2,500 GPs found over a quarter did not wait for a microscopy report before prescribing oral antifungal treatment for suspected nail infections.
The survey – published in the journal Mycoses last month – found waiting times and a lack of clear guidance for GPs from laboratories contributed to a high rate of oral antifungal prescribing.
Oral antifungals were used more frequently than topical agents, with 28% of GPs using them in over half of cases. Only 8% prescribed oral agents because topical antifungals had not been effective.
Hepatoxicity has been reported with terbinafine and itraconazole, and the audit found that GPs do not routinely perform assessments for pre-existing liver disease, with only 15% assessing liver function before starting oral antifungal treatment, and 36% never requesting liver function tests.
Study leader Gemma Lasseter, microbiologist with the HPA’s Primary Care Unit, said: ‘Our results show that GPs should rely more heavily on laboratory results when choosing expensive and lengthy treatment regimes.’
‘Microbiology laboratory specimen reporting systems should be updated to provide GPs with treatment guidance for each positive patient, thus ensuring that superficial fungal infections are managed similarly throughout the UK.’