Oral Treatments for Toenail Onychomycosis

Crawford, Fay; Young, Philip J.; Godfrey, Christine; Bell-Syer, Sally EM; Hart, Rachel; Brunt, Elizabeth M.; Russell, Ian

doi:10.1001/archderm.138.6.811

Cited by 82 publications

(28 citation statements)

References 53 publications

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“…Terbinafine is considered to be the most efficacious antifungal agent for treatment of toenail onychomycosis. 9,16,23,[39][40][41][42][43][44] The target toenail mycological and complete cure rates for standard, continuous-dose terbinafine observed for our study, 71% and 41%, respectively, are similar to most previously reported studies using the same dose and duration of treatment. 23,24,40,[45][46][47][48][49][50][51][52] The target toenail mycological cure rate for pulse terbinafine observed for our study, 59%, is also similar to previous studies.…”

Section: Discussionsupporting

confidence: 88%

Pulse versus continuous terbinafine for onychomycosis: A randomized, double-blind, controlled trial

Warshaw

Fett

Bloomfield

et al. 2005

Journal of the American Academy of Dermatology

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Section: Discussionsupporting

confidence: 88%

Pulse versus continuous terbinafine for onychomycosis: A randomized, double-blind, controlled trial

Warshaw

Fett

Bloomfield

et al. 2005

Journal of the American Academy of Dermatology

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“…Trichophyton rubrum, among other dermatophytes, is a major causative agent for superficial dermatomycoses like onychomycosis and tinea pedis (19,26) and is known to account for as many as 69.5% of all dermatophyte infections (4,5,18). Common therapeutic strategies based on the use of terbinafine and griseofulvin are generally considered effective (6,7,11). Terbinafine is very widely used, both orally and topically, in the therapy of dermatophyte infections, with no reports of resistance against this allylamine antifungal (16,24).…”

mentioning

confidence: 99%

Clinical Trichophyton rubrum Strain Exhibiting Primary Resistance to Terbinafine

Mukherjee

Leidich

Isham

et al. 2003

Antimicrob Agents Chemother

274

226

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The in vitro antifungal susceptibilities of six clinical Trichophyton rubrum isolates obtained sequentially from a single onychomycosis patient who failed oral terbinafine therapy (250 mg/day for 24 weeks) were determined by broth microdilution and macrodilution methodologies. Strain relatedness was examined by random amplified polymorphic DNA (RAPD) analyses. Data obtained from both broth micro-and macrodilution assays were in agreement and revealed that the six clinical isolates had greatly reduced susceptibilities to terbinafine. The MICs of terbinafine for these strains were >4 g/ml, whereas they were <0.0002 g/ml for the susceptible reference strains. Consistent with these findings, the minimum fungicidal concentrations (MFCs) of terbinafine for all six strains were >128 g/ml, whereas they were 0.0002 g/ml for the reference strain. The MIC of terbinafine for the baseline strain (cultured at the initial screening visit and before therapy was started) was already 4,000-fold higher than normal, suggesting that this is a case of primary resistance to terbinafine. The results obtained by the broth macrodilution procedure revealed that the terbinafine MICs and MFCs for sequential isolates apparently increased during the course of therapy. RAPD analyses did not reveal any differences between the isolates. The terbinafine-resistant isolates exhibited normal susceptibilities to clinically available antimycotics including itraconazole, fluconazole, and griseofulvin. However, these isolates were fully cross resistant to several other known squalene epoxidase inhibitors, including naftifine, butenafine, tolnaftate, and tolciclate, suggesting a target-specific mechanism of resistance. This is the first confirmed report of terbinafine resistance in dermatophytes.

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“…[28][29][30][31] In routine practice, topical antifungal treatments (azoles) are often added in the first few weeks for a faster response. 32 Systemic treatment is usually needed for four to six weeks for tinea corporis and three months for associated foot onychomycosis.…”

Section: Discussionmentioning

confidence: 99%