Limited availability of generic antifungals across the world

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In a global analysis, GAFFI has identified major gaps in antifungal drug provision for common fungal infections. From multiple sources—most directly from individual countries—it shows flucytosine availability in 24% (map), amphotericin B deoxycholate in 49% (map), itraconazole in 93% (map) and fluconazole in 98% (map) of countries (including PEPFAR provision). No vital antifungals are available in Afghanistan. Interactive versions of our availability and pricing maps are available here.

amphotericin worldwide availability

Amphotericin B availability worldwide (2014)


Fluconazole was only found in one formulation in 17 countries—usually as a single 150mg capsule for vaginal candidiasis. In other countries, multiple generic preparations and dosages are available (eg 38 in Greece and 98 in India). Itraconazole is unavailable in Eritrea, Senegal, Burundi, Algeria, Dominican Republic or Ukraine. Only one preparation is available in 28 countries; this is in contrast to multiple preparations in several countries (eg 33 in Greece and 25 in Mexico).

The work was presented at the 25th ECCMID meeting in Barcelona. Professor Denning from GAFFI commented: “It is self-evident that countries without access to key antifungal therapies cannot provide adequate outcomes for their populations of patients with serious fungal diseases. Fluconazole is a critical agent for candidiasis and cryptococcal meningitis; itraconazole for aspergillosis.”

A partial assessment of the costs of the drugs in each country reveals extraordinary variation. Exchange rates were calculated via XE.com. Iran has the lowest flucytosine (5g daily) price at $0.56 and South Korea the highest-priced formulation at $1319.14. Zambia has the lowest prices internationally for fluconazole (800mg daily) at <$0.01, itraconazole (400mg daily) <$0.01 and amphotericin B (50mg daily) at <$0.01. The range of available daily prices for fluconazole was $0.01–659.30, for itraconazole $0.01–105.50 and for amphotericin B was $0.01-171.47 (excluding liposomal formulations).

Number of generic formulations of itraconazole in each country worldwide

Number of generic formulations of itraconazole in each country worldwide (2014)


While some of these prices reflect each country’s GDP, most do not. Generic products usually had lower prices than original trade name products (ie Sporonox and Diflucan), but not always. Some countries only had the less toxic and clinically preferable liposomal amphotericin B available, but this increased costs substantially (up to $395.25 for a single daily dose).

View the full poster here.