title: Use of clotrimazole/betamethasone diproprionate by family physicians.
abstract: OBJECTIVE
  Clotrimazole/betamethasone diproprionate contains a fluorinated, high-potency topical corticosteroid and is the most frequently prescribed topical agent in the United States. Family physicians are more likely than pediatricians and dermatologists to use this product when faced with a common fungal infection. To better understand the settings in which US family physicians recommend the use of clotrimazole/betamethasone diproprionate, we determined the diagnoses and characteristics of patients for whom family physicians prescribe this drug.
  
  
  METHODS
  Data from the National Ambulatory Medical Care Survey were used to determine the demographic characteristics of patients who were given a prescription for clotrimazole/betamethasone diproprionate, the diagnoses of patients treated with the drug, and the potency of other topical corticosteroids by family physicians. Wholesale costs of drugs were used to estimate potential drug cost savings obtainable by switching to specific monotherapy agents.
  
  
  RESULTS
  Clotrimazole/betamethasone diproprionate was prescribed at 3.1% of visits to family physicians but at only .6% of visits to dermatologists for either inflammatory or fungal/candidal conditions. Family physicians frequently prescribed clotrimazole/betamethasone diproprionate to children under age 5 and for use on genital skin disorders. Dermatologists rarely used clotrimazole/betamethasone diproprionate in these settings.
  
  
  CONCLUSIONS
  The frequent use by family physicians of clotrimazole/betamethasone diproprionate in high-risk settings is of concern. Use of alternative agents with anti-inflammatory and antifungal properties without the risks associated with the use of high-potency topical corticosteroids may be the most practical approach to replacing use of clotrimazole/betamethasone diproprionate.
authors.affiliation: Department of Dermatology, Wake Forest University, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Shaffer
authors.forename: S R
authors.initials: SR
authors.lastname: Feldman
authors.forename: A B
authors.initials: AB
authors.lastname: Fleischer
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001623:Betamethasone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy; D002675:Child, Preschool; D003022:Clotrimazole / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D017046:Cost Savings; D003710:Demography; D003880:Dermatology; D004338:Drug Combinations; D016527:Drug Costs; D011307:Drug Prescriptions; D004363:Drug Utilization; D005194:Family Practice; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000145:classification / Q000188:drug therapy; D010372:Pediatrics; D014481:United States
chemical_list: D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D004338:Drug Combinations; D005938:Glucocorticoids; C011175:betamethasone-17,21-dipropionate; D001623:Betamethasone; D003022:Clotrimazole