Introduction: According to European Surveillance of Antimicrobial Consumption Network (ESAC-Net) 2023 report, Belgium ranked second in systemic antimycotic and antifungal use in Europe, reaching nearly triple the European average.

Objectives: This study examines national consumption trends between 2014 and 2023 across care settings.

Methods: Data from ESAC-Net were used to assess reimbursed consumption of systemic antimycotics (ATC group J02A) and antifungals (ATC D01BA). Defined daily doses (DDDs) per 1000 inhabithants/day (DID) were calculated using the WHO ATC/DDD Index 2023 and Eurostat population data. Relative change and temporal trends were assessed using percentage variation and Spearman’s rank correlation.

Results: In 2023, 96.2% of antifungals/antimycotics DDDs were dispensed in the community, where use was exclusively oral. Hospital use represented 3.8% of total consumption, with 60.2% oral and 39.8% parenteral formulations. In the community, terbinafine (D01BA02), fluconazole (J02AC01), and itraconazole (J02AC02) accounted for most use. Terbinafine increased (+17.9%, p = 0.29), while fluconazole (-9.9%, p < 0.01) and itraconazole (-24.1%, p < 0.01) declined significantly. In hospitals, fluconazole remained dominant, followed by isavuconazole, voriconazole, and posaconazole. Hospital consumption declined (-27.3%, p < 0.01), notabily fluconazole (37.1%, p < 0.01) and itraconazole (-61.3%, p < 0.01). Isavuconazole use began in 2019 and surge considerably since 2020 (+13422.0%, p = 0.0167). Amphotericin B decreased (-41.0%, p = 0.03) to reached its lowest levels in 2023. Posaconazole (-11.8%, p = 0.55) and voriconazole (–46.0%, p = 0.70) showed no significant trends. Between 2014 and 2023, overall consumption declined modestly but significantly (-3.4%, p = 0.04). A sharp drop in community use occurred in 2020 – likely due to COVID-19 – but returned to near-2016 levels by 2023.

Conclusion: Despite a temporary drop during the COVID-19 pandemic, antifungal consumption in Belgium remains high, especially in outpatient care. The increasing post-2020 trend and continued reliance on azoles and terbinafine— particularly in a context of emerging resistance in Candida, Aspergillus, and dermatophytes—highlight the need for reinforced antifungal stewardship.