Terbinafine and itraconazole in the treatment of onychomycosis Review article
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Published:
Mar 31, 2017
Keywords:
terbinafine, itraconazole, onychomycosis
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Abstract
Onychomycosis is a frequently found dermatosis. The aim of it’s treatment is to eliminate the infection and restore the normal appearance of the nail plate. In clinical practice, it is essential to select a proper drug. Most frequently used in systemic therapy are terbinafine and itraconazole. As the treatment of choice the oral administration of one of these two antifungal drugs are recommended. Clinical studies have demonstrated a high effectiveness of the terbinafine and itraconazole oral therapy in the treatment of onychomycosis. Some recommendations, however, draws attention to the fact that terbinafine in onychomycosis caused by dermatophytes should be treated as a first-line treatment, and itraconazole as it’s best alternative. The recommendations also indicate the efficacy of itraconazole in the treatment of mixed infections of nails caused by mold fungi and yeasts. The paper presents the literature data on comparative studies and analyzes influencing the choice of therapy.
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Owczarek, W. (2017). Terbinafine and itraconazole in the treatment of onychomycosis. Medycyna Faktow (J EBM), 10(1(34), 38-41. Retrieved from https://journalsmededu.pl/index.php/jebm/article/view/2192
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References
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5. Maleszka R., Adamski A., Szepietowski J. et al.: Leczenie powierzchownych zakażeń grzybiczych – rekomendacje ekspertów Sekcji Mikologicznej Polskiego Towarzystwa Dermatologicznego. Przegl. Dermatol. 2015; 102: 305-315.
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9. Goodfield M.J., Andrew L., Evans E.G.: Short term treatment of dermatophyte onychomycosis with terbinafine. BMJ 1992; 304: 1151-1154.
10. Gupta A.K., De Doncker P., Scher R.K. et al.: Itraconazole for the treatment of onychomycosis. Int. J. Dermatol. 1998; 37: 303-308.
11. Havu V., Brandt D., Heikkila H. et al.: A double-blind, randomised study comparing itraconazole pulse therapy with continuous dosing for the treatment of toe-nail onychomycosis. Br. J. Dermatol. 1997; 136: 230-234.
12. De Doncker P., Decroix J., Pierard G.E. et al.: Antifungal pulse therapy for onychomycosis: A pharmacokinetic and pharmacodynamic investigation of monthly cycles of 1-week pulse therapy with itraconazole. Arch. Dermatol. 1996; 132: 34-41.
13. Sigurgeirsson B., Olafsson J.H., Steinsson J.P. et al.: Long-term effectiveness of treatment with terbinafine vs itraconazole in onychomycosis: a 5-year blinded prospective follow-up study. Arch. Dermatol. 2002; 138: 353-337.
14. Pajaziti L., Vasili E.: Treatment of Onychomycosis – a Clinical Study. Med. Arch. 2015; 69(3): 173-176.
15. Baran R., Kaoukhov A.: Topical antifungal drugs for the treatment of onychomycosis: an overview of current srategies for monotherapy and combination therapy. JEADV 2005; 19: 21-29.
16. Gupta A.K.: Pharmacoeconomic analysis of ciclopirox nail lacquer solution 8% and the new oral antifungal agents used to treat dermatophyte toe onychomycosis in the United States. J. Am. Acad. Dermatol. 2000; 43(4 Suppl.): 81-95.
17. Krob A.H., Fleischer A.B. Jr, D’Agostino R. Jr et al.: Terbinafine is more effective than itraconazole in treating toenail onychomycosis: results from a meta-analysis of randomized controlled trials. J. Cutan. Med. Surg. 2003; 7(4): 306-311.
18. Haugh M., Helou S., Boissel J.P. et al.: Terbinafine in fungal infections of the nails: a meta-analysis of randomized clinical trials. Br. J. Dermatol. 2002; 147(1): 118-121.
19. Trivedi N.A., Shah P.C.: A meta-analysis comparing efficacy of continuous terbinafine with intermittent itraconazole for toenail onychomycosis. Indian J. Dermatol. 2010; 55(2): 198-199.
20. Gupta A.K., Daigle D., Foley K.A.: Network Meta-Analysis of Onychomycosis Treatments. Skin Appendage Disord. 2015; 1(2): 74-81.
21. Roberts D., Taylor W.D., Boyle D.J.: Guidelines for treatment of onychomycosis. Br. J. Dermatol. 2003; 148: 402-410.
22. Cohen A.D., Medvesovsky E., Shalev R. et al.: An independent comparison of terbinafine and itraconazole in the treatment of toenail onychomycosis. J. Dermatolog. Treat. 2003; 14(4): 237-242.
23. Chang C.H., Young-Xu Y., Kurth T. et al.: The safety of oral antifungal treatments for superficial dermatophytosis and onychomycosis: a meta-analysis. Am. J. Med. 2007; 120(9): 791-798.
24. Szepietowski J.: Grzybice skóry i paznokci. Medycyna Praktyczna, Kraków 2001.
25. Ameen M., Lear J.T., Madan V. et al.: British Association of Dermatologists’ guidelines for the management of onychomycosis 2014. Br. J. Dermatol. 2014; 171(5): 937-958.
2. Nenoff P., Krüger C., Ginter-Hanselmayer G. et al.: Mycology – an update. Part 1: Dermatomycoses: causative agents, epidemiology and pathogenesis. J. Dtsch. Dermatol. Ges. 2014; 12: 188-211.
3. Sigurgeirsson B., Baran R.: The prevalence of onychomycosis in the global population – a literature study. J. Eur. Acad. Dermatol. Venereol. 2014; 28: 1480-1491.
4. Effendy I., Lecha M., Feuilhade de Chauvin M. et al.: Epidemiology and clinical classification of onychomycosis. J. Eur. Acad. Dermatol. Venereol. 2005; 19: 8-12.
5. Maleszka R., Adamski A., Szepietowski J. et al.: Leczenie powierzchownych zakażeń grzybiczych – rekomendacje ekspertów Sekcji Mikologicznej Polskiego Towarzystwa Dermatologicznego. Przegl. Dermatol. 2015; 102: 305-315.
6. Barber K., Barber J.: Onychomycosis: therapy directed by morphology and mycology. Skin Therapy Lett. 2009; 14(1): 1-2.
7. Richardson M.D., Warnock D.W.: Grzybice. Rozpoznawanie i leczenie. Springer PWN, Warszawa 1995.
8. Hofmann H., Brautigam M., Weidinger G. et al.: Treatment of toenail onychomycosis. A randomized, double-blind study with terbinafine and griseofulvin. LAGOS II Study Group. Arch. Dermatol. 1995; 131: 919-922.
9. Goodfield M.J., Andrew L., Evans E.G.: Short term treatment of dermatophyte onychomycosis with terbinafine. BMJ 1992; 304: 1151-1154.
10. Gupta A.K., De Doncker P., Scher R.K. et al.: Itraconazole for the treatment of onychomycosis. Int. J. Dermatol. 1998; 37: 303-308.
11. Havu V., Brandt D., Heikkila H. et al.: A double-blind, randomised study comparing itraconazole pulse therapy with continuous dosing for the treatment of toe-nail onychomycosis. Br. J. Dermatol. 1997; 136: 230-234.
12. De Doncker P., Decroix J., Pierard G.E. et al.: Antifungal pulse therapy for onychomycosis: A pharmacokinetic and pharmacodynamic investigation of monthly cycles of 1-week pulse therapy with itraconazole. Arch. Dermatol. 1996; 132: 34-41.
13. Sigurgeirsson B., Olafsson J.H., Steinsson J.P. et al.: Long-term effectiveness of treatment with terbinafine vs itraconazole in onychomycosis: a 5-year blinded prospective follow-up study. Arch. Dermatol. 2002; 138: 353-337.
14. Pajaziti L., Vasili E.: Treatment of Onychomycosis – a Clinical Study. Med. Arch. 2015; 69(3): 173-176.
15. Baran R., Kaoukhov A.: Topical antifungal drugs for the treatment of onychomycosis: an overview of current srategies for monotherapy and combination therapy. JEADV 2005; 19: 21-29.
16. Gupta A.K.: Pharmacoeconomic analysis of ciclopirox nail lacquer solution 8% and the new oral antifungal agents used to treat dermatophyte toe onychomycosis in the United States. J. Am. Acad. Dermatol. 2000; 43(4 Suppl.): 81-95.
17. Krob A.H., Fleischer A.B. Jr, D’Agostino R. Jr et al.: Terbinafine is more effective than itraconazole in treating toenail onychomycosis: results from a meta-analysis of randomized controlled trials. J. Cutan. Med. Surg. 2003; 7(4): 306-311.
18. Haugh M., Helou S., Boissel J.P. et al.: Terbinafine in fungal infections of the nails: a meta-analysis of randomized clinical trials. Br. J. Dermatol. 2002; 147(1): 118-121.
19. Trivedi N.A., Shah P.C.: A meta-analysis comparing efficacy of continuous terbinafine with intermittent itraconazole for toenail onychomycosis. Indian J. Dermatol. 2010; 55(2): 198-199.
20. Gupta A.K., Daigle D., Foley K.A.: Network Meta-Analysis of Onychomycosis Treatments. Skin Appendage Disord. 2015; 1(2): 74-81.
21. Roberts D., Taylor W.D., Boyle D.J.: Guidelines for treatment of onychomycosis. Br. J. Dermatol. 2003; 148: 402-410.
22. Cohen A.D., Medvesovsky E., Shalev R. et al.: An independent comparison of terbinafine and itraconazole in the treatment of toenail onychomycosis. J. Dermatolog. Treat. 2003; 14(4): 237-242.
23. Chang C.H., Young-Xu Y., Kurth T. et al.: The safety of oral antifungal treatments for superficial dermatophytosis and onychomycosis: a meta-analysis. Am. J. Med. 2007; 120(9): 791-798.
24. Szepietowski J.: Grzybice skóry i paznokci. Medycyna Praktyczna, Kraków 2001.
25. Ameen M., Lear J.T., Madan V. et al.: British Association of Dermatologists’ guidelines for the management of onychomycosis 2014. Br. J. Dermatol. 2014; 171(5): 937-958.