In Vitro Combination Effect of Topical and Oral Anti-Onychomycosis Drugs on Trichophyton rubrum and Trichophyton interdigitale

Sugiura, Keita; Masumoto, Akane; Tachibana, Haruki; Tatsumi, Yoshiyuki

doi:10.3390/jof7030208

Cited by 11 publications

(11 citation statements)

References 34 publications

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“…Conversely, luliconazole showed no synergistic effect with terbinafine but was synergistically effective with itraconazole against 31.3% of the strains. Tavaborole (an inhibitor of protein synthesis in fungal cells) showed no synergistic effect with terbinafine and was synergistically effective with itraconazole against 18.8% of the strains [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

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Antifungal Combinations in Dermatophytes

Brescini

Fioriti

Morroni

et al. 2021

JoF

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Dermatophytes are the most common cause of fungal infections worldwide, affecting millions of people annually. The emergence of resistance among dermatophytes along with the availability of antifungal susceptibility procedures suitable for testing antifungal agents against this group of fungi make the combinatorial approach particularly interesting to be investigated. Therefore, we reviewed the scientific literature concerning the antifungal combinations against dermatophytes. A literature search on the subject performed in PubMed yielded 68 publications: 37 articles referring to in vitro studies and 31 articles referring to case reports or clinical studies. In vitro studies involved over 400 clinical isolates of dermatophytes (69% Trichophyton spp., 29% Microsporum spp., and 2% Epidermophyton floccosum). Combinations included two antifungal agents or an antifungal agent plus another chemical compound including plant extracts or essential oils, calcineurin inhibitors, peptides, disinfectant agents, and others. In general, drug combinations yielded variable results spanning from synergism to indifference. Antagonism was rarely seen. In over 700 patients with documented dermatophyte infections, an antifungal combination approach could be evaluated. The most frequent combination included a systemic antifungal agent administered orally (i.e., terbinafine, griseofulvin, or azole—mainly itraconazole) plus a topical medication (i.e., azole, terbinafine, ciclopirox, amorolfine) for several weeks. Clinical results indicate that association of antifungal agents is effective, and it might be useful to accelerate the clinical and microbiological healing of a superficial infection. Antifungal combinations in dermatophytes have gained considerable scientific interest over the years and, in consideration of the interesting results available so far, it is desirable to continue the research in this field.

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Section: Resultsmentioning

confidence: 99%

“…and E. floccosum. Combinations included amorolfine plus azoles or terbinafine or griseofulvin; azoles plus griseofulvin or terbinafine; azoles plus ciclopirox [24][25][26][27][28][29][30]. Checkerboard titration methodology was the most common procedure for testing a combination (6/7 studies).…”

Section: Antifungal Combinationsmentioning

confidence: 99%

Antifungal Combinations in Dermatophytes

Brescini

Fioriti

Morroni

et al. 2021

JoF

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“…An antifungal susceptibility study in vitro using the fractional inhibitory concentration index suggested that terbinafine and efinaconazole had synergic or additive effects on most T. rubrum and Trichophyton interdigitale strains investigated. 13 The mechanism underlying the synergy effect may involve the blockage of both SQLE and 14α‐demethylase. These in vitro synergy effects led to favorable clinical efficacy in the patient’s nail during our sequential combination therapy.…”

Section: Discussionmentioning

confidence: 99%

Topical efinaconazole: A sequential combination therapy with oral terbinafine for refractory tinea unguium

Noguchi¹,

Kubo

Kashiwada‐Nakamura

et al. 2021

The Journal of Dermatology

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Efinaconazole is a topical antifungal drug used to treat tinea unguium that was approved by the Japanese government in 2014.A phase 3 study enrolled patients with a nail involvement ratio of 20-50% (mean, 36.7%), and the complete cure rate at 52 weeks was 17.8% (117/656). 1 Furthermore, a multicenter study including severe cases with a mean nail involvement of 49.1% showed that continuous application up to 72 weeks contributed to a relatively high cure rate of 31.1% (68/223). 2 A recent Cochrane review of treatments for onychomycosis confirmed that high-quality evidence supports the effectiveness of efinaconazole for achieving a complete cure. 3 Oral terbinafine at 250 mg daily for 12 weeks and oral itraconazole pulse therapy (3 cycles of 400 mg daily) are mainly applied internationally, with complete cure rates of 35% and 14%, respectively. 4

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“…In such instances, a higher dose or longer duration of antifungal therapy may be required, an alternate antifungal class may be selected, 77 or the use of combination therapy may be relevant. 78,79…”

Section: Antifungal Susceptibility Testingmentioning

confidence: 99%

Combatting antifungal resistance: Paradigm shift in the diagnosis and management of onychomycosis and dermatomycosis

Gupta

Talukder

Carviel

et al. 2023

Acad Dermatol Venereol

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Antifungal resistance has become prevalent worldwide. Understanding the factors involved in spread of resistance allows the formulation of strategies to slow resistance development and likewise identify solutions for the treatment of highly recalcitrant fungal infections. To investigate the recent explosion of resistant strains, a literature review was performed focusing on four main areas: mechanisms of resistance to antifungal agents, diagnosis of superficial fungal infections, management, and stewardship. The use of traditional diagnostic tools such as culture, KOH analysis and minimum inhibitory concentration values on treatment were investigated and compared to the newer techniques such as molecular methods including whole genome sequencing, and polymerase chain reaction. The management of terbinafine‐resistant strains is discussed. We have emphasized the need for antifungal stewardship including increasing surveillance for resistant infection.

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In Vitro Combination Effect of Topical and Oral Anti-Onychomycosis Drugs on Trichophyton rubrum and Trichophyton interdigitale

Cited by 11 publications

References 34 publications

Antifungal Combinations in Dermatophytes

Antifungal Combinations in Dermatophytes

Topical efinaconazole: A sequential combination therapy with oral terbinafine for refractory tinea unguium

Combatting antifungal resistance: Paradigm shift in the diagnosis and management of onychomycosis and dermatomycosis

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