Fungal infections are a growing public health challenge, especially among vulnerable populations. In this context, access to effective antifungals is essential for treatment. In Brazil, the SUS provides these medications but faces difficulties in distribution and access, affecting clinical outcomes. This study analyzes the distribution of essential antifungals within SUS, highlighting regional disparities and strategies to improve access. This documentary and descriptive study used secondary data from the Ministry of Health Transparency Portal, public databases of the Department of Pharmaceutical Assistance and Strategic Supplies, and official reports from the Secretariat of Health Surveillance between 2015 and 2024. Data on acquisition, distribution, and consumption of major antifungals—fluconazole, amphotericin B (conventional and liposomal), itraconazole, and voriconazole—were collected. The analysis focused on population coverage by geographic region, distributed quantities, and temporal variation. A review of technical documents identified logistical and policy barriers related to access. Between 2015 and 2024, fluconazole had the highest distribution, accounting for 85% of antifungal treatments in SUS. Conventional amphotericin B showed stable distribution, whereas liposomal amphotericin B had limited availability, concentrated in the South and Southeast regions. The North and Northeast had lower acquisition and distribution volumes relative to population needs, with an average deficit of 20% in coverage. Itraconazole and voriconazole had restricted distribution, particularly voriconazole, used in aspergillosis. Barriers included supply chain failures, budget constraints, and lack of uniform clinical protocols for antifungal use. Additionally, difficulties in training healthcare professionals for adequate prescribing and management were identified. Regional inequality in access to essential antifungals within SUS highlights the need to strengthen public policies and distribution processes. The concentration of costly antifungals in only a few regions compromises the care of severe cases. Lack of uniform protocols and professional training increases the risk of inappropriate use and resistance. Investing in logistics and education is therefore essential to combat fungal infections in Brazil.
Stocki et al. (Sun,) studied this question.