Authors’ Reply to Denning: Comment on: “Global Consumption Trend of Antifungal Agents in Humans From 2008 to 2018: Data From 65 Middle- and High-Income Countries”

Abstract

thank you for the opportunity to respond to the comments raised in Prof. Denning’s letter. We also thank Prof. Denning for taking an interest in our paper and speculating on possibilities for an increase in itraconazole consumption, particularly in middle-income countries.

In his letter [1], Prof. Denning postulated reasons for the increased consumption of itraconazole, preceding its listing in the World Health Organization (WHO)’s Essential Medicine List (EML) in 2017. We agree that several factors, including the inclusion of itraconazole into the chronic pulmonary aspergillosis (CPA) guideline in early 2016, the high prevalence of recurrent vulvovaginal candidiasis, and the increased awareness about histoplasmosis in patients with acquired immunodeficiency syndrome in African countries, could influence the increase in overall consumption of itraconazole in middle-income countries.