Emerging threat in antifungal resistance on superficial dermatophyte infection

Abstract

Background: Dermatophytosis are most common fungul infection globally and according to WHO the prevalence is about 20-25% and does not spare people of any race or age. Over the past few years antifungal resistance has been emerged due to irrational use of antifungal drugs in cutaneous mycosis.
 Objective: The aim of the study is to evaluate the efficacy of different antifungul drugs (Terbinafin. Fluconazole, Itraconazole, Griseofulvin) on superficial mycosis depending on various factors.
 Methods: This prospective study was conducted among the Superficial fungul infected patients from April' 2017 to October 2017 in Khulna Medical College Hospital (KMCH) and dermatologist's private chamber in Khulna city. All the enrolled patients were put on oral Terbinafin, Fluconazole, Itraconazole and Griseofulvin. Each patient was given single antifungal drug orally. These cases were thus followed up after two months of treatment to look for persistent infection, cure or any relapse clinically.
 Result: Among 194 patient 89 were given Tab. Terbinafin (250mg) where resistance cases were 20.22%. More cases (33.96%) were resistant to Cap. Fluconazol (50mg). High percentage of cases were resistant to Cap. Itraconazole (76.47%). Griseofulvin resistant cases were observed in 25.71%. Drug response is very poor (69%) in patient who had been suffering from diabetes mellitus.
 Conclusion: Appropriate antifungal drugs should be chosen with strict indication, dose, duration, selection of perfect local preparation and taking laboratory facilities where necessary.
 Bang Med J (Khulna) 2018; 51 : 21-24

A comparative study of efficacy of oral itraconazole, terbinafine and fluconazole: a clinical trial

“…Least drug resistance was found with terbinafine. 11 We had parallel findings with a study by Singh et al who found that itraconazole is the most effective drug, followed by fluconazole (daily), terbinafine and then griseofulvin in chronic and chronic relapsing dermatophytosis in India. 12 In a study done on a patient with long term recurrent tinea corporis by Ardeshna et al isotretinoin(20 mg/day) was combined with itraconazole (200 mg/day).…”

Assessment of factors related to treatment failure and recurrence of superficial dermatophytosis

“…affected. 3,9,[10][11][12][13] The predisposition of infection among adults may be attributed to their greater physical activity, mobility, and perspiration that aids in the proliferation of the fungus. Previous studies reported the association of recurrent dermatophytosis with various risk factors such as occupation, family history of dermatophytosis, preexisting comorbidity, excessive sweating, type of undergarments (tight fit), poor frequency of washing clothes, sharing of a towel/clothes, frequency of taking baths, and prior use of topical steroids.…”