Unwarranted co-prescribing of antifungals with antibiotics widespread in Armenia, experts say

The routine co-prescribing of antifungal medications alongside antibiotics remains widespread in Armenia despite a lack of medical justification in most cases, according to specialists at the Heratsi Research Center and a study conducted by the Department of Pharmaceutical Management at Yerevan State Medical University.

Experts say a common misconception among both the public and some healthcare providers is that antifungal drugs should automatically accompany antibiotic treatment to prevent fungal infections. International clinical guidelines, however, do not recommend routine prophylactic antifungal therapy for most patients receiving antibiotics.

While broad-spectrum antibiotics can disrupt the body's normal microbial flora, this alone does not mean patients will develop clinically significant fungal infections. Studies indicate that an estimated 30% to 50% of antifungal prescriptions worldwide are unnecessary or suboptimal.

Unwarranted antifungal use can contribute to antifungal resistance, increase the risk of liver toxicity and drug interactions, and impose unnecessary costs on patients and healthcare systems, experts said.

Preventive antifungal therapy is generally recommended only for high-risk patients, including those with moderate to severe immunosuppression, hematological diseases, prolonged high-dose antibiotic treatment, or those receiving intensive care and invasive procedures.

The Yerevan State Medical University study found that antifungals are frequently recommended alongside antibiotics in Armenia, often without confirmed fungal infection or clear clinical indications. Researchers said the practice is driven largely by a perception of prevention and safety, particularly in pharmacy settings, where some staff recommend antifungal drugs without a confirmed diagnosis.

The findings also highlighted knowledge gaps among both pharmacy personnel and the public regarding the relationship between antibiotic use and fungal infections, contributing to irrational prescribing and self-medication.

Researchers said the findings underscore the need for stronger public health education, enhanced professional training and tighter oversight of prescribing and dispensing practices to promote the rational use of antimicrobial medicines.