Use of clotrimazole/betamethasone diproprionate by family physicians

Background and Objectives: Clotrimazole/betamethasone diproprionate contain s a fluorinated, high-potency topical corticosteroid and is the most freque ntly prescribed topical agent in the United States. Family physicians are m ore likely than pediatricians and dermatologists to use this product when f aced with a common fungal infection. To better understand the settings in w hich US family physicians recommend the use of clotrimazole/betamethasone d iproprionate, we determined the diagnoses and characteristics of patients f or whom family physicians prescribe this drug. Methods: Data from the Natio nal Ambulatory Medical Care Survey were used to determine the demographic c haracteristics of patients who were given a prescription for clotrimazole/b etamethasone diproprionate, the diagnoses of patients treated with the drug , and the potency of other topical corticosteroids by family physicians. Wh olesale costs of drugs were used to estimate potential drug cost savings ob tainable by switching to specific monotherapy agents. Results: Clotrimazole /betamethasone diproprionate was prescribed at 3.1% of visits to family phy sicians but at only .6% of visits to dermatologists for either inflammatory or fungal/candidal conditions. Family physicians frequently prescribed clo trimazole/betamethasone diproprionate to children under age 5 and for use o n genital skin disorders. Dermatologists rarely used clotrimazole/betametha sone diproprionate in these settings. Conclusions: The frequent use by fami ly physicians of clotrimazole/betamethasone diproprionate in high-risk sett ings is of concern. Use of alternative agents with anti-inflammatory and an tifungal properties without the risks associated with the use of high-poten cy topical corticosteroids may be the most practical approach to replacing use of clotrimazole/betamethasone diproprionate.