A comparative study of mycological efficacy of terbinafine and fluconazole in patients of tinea corporis

Kumar, Amit; Budania, Navin; Sharma, Priyamvada; Singh, Monika

doi:10.7439/ijbr.v4i11.388

Cited by 6 publications

(7 citation statements)

References 7 publications

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“…It was found that at completion of the study a higher number patients on terbinafine were clinically cured in comparison to itraconazole. A comparative study by Amit et al (2013) found that terbinafine showed slightly better results than fluconazole in tinea corporis [17]. Terbinafine was reported to have 91% cure rate in tinea corporis and cruris patients, by a study conducted by Shivakumar et al (2011) Nevertheless, the finding in our study does not imply that itraconazole is less efficacious than terbinafine [18].…”

Section: Discussioncontrasting

confidence: 63%

Prescription Audit of Anti-fungal Treatment of Dermatophytoses in the Dermatology Out Patient Department of a Tertiary Care Hospital

2019

IJCED

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Aims: To study the prescriptions of clinically diagnosed cases of dermatophytoses, to evaluate medical treatment of clinical failure cases, any rise in serum ALT (Alanine aminotransferase) levels associated with usage of oral anti-fungal drugs, availability of drugs in the hospital pharmacy and cost minimization of different oral treatment regimens with Griseofulvin, Fluconazole, Itraconazole and Terbinafine. Settings and design: Dermatology Out Patient Department (OPD) of a tertiary care hospital, single centre prospective cohort observational study. Materials and Methods: 370 patients from the Dermatology Out Patient Department (OPD) diagnosed of dermatophytoses were enrolled. Follow-up was done 3±1 weeks apart, twice for newly diagnosed patients and once for patients on ongoing therapy. Two separate blood samples were collected 3±1 weeks apart for estimation of serum ALT. The prime lesion in each patient was graded as mild, moderate and severe. Patients were categorized as clinically cured, clinically improved, or as clinical failure following treatment. Statistical analysis used: Descriptive statistics, Fischer’s exact test and Wilcoxon’s signed rank test. Results: Azoles were the most commonly prescribed antifungals. Clinical status of patients was independent of the oral antifungal drug received (p > 0.05). A statistically significant difference in clinical status between compliant and non-compliant patients was seen (p < 0.05). A statistically significant increase in serum ALT levels was seen (p < 0.05) however, it was not clinically significant. 55.52% of drugs were unavailable in the hospital formulary. The average expenses per prescription was approximately INR 1123.55. Itraconazole was the most expensive treatment regimen followed by terbinafine and fluconazole. Conclusions: There exists a non-uniformity in the management of dermatophytoses due to lack of adequate guidance and nonavailability of drugs and clinical cure of patients depends upon compliance to therapy.

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Section: Discussioncontrasting

confidence: 63%

Prescription Audit of Anti-fungal Treatment of Dermatophytoses in the Dermatology Out Patient Department of a Tertiary Care Hospital

2019

IJCED

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“…No clinical trials of daily fluconazole, itraconazole or griseofulvin in tinea corporis, tinea cruris or tinea faciei conducted in India in the decade preceding 2013 could be found on a PubMed search. With regard to terbinafine, two trials were found in this period, which showed high cure rates (93% with 250 mg once every 3 days for 3 weeks in 2007–2008,7 and 76% with 250 mg per day for 4 weeks in 2010–20118 in tinea corporis and tinea cruris).…”

Section: Discussionmentioning

confidence: 99%

Limited effectiveness of four oral antifungal drugs (fluconazole, griseofulvin, itraconazole and terbinafine) in the current epidemic of altered dermatophytosis in India: results of a randomized pragmatic trial*

et al. 2020

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Summary Background Dermatophytic infections have undergone unprecedented changes in India in the recent past. Clinical trials to find out the effectiveness of the four main oral antifungal drugs are lacking. Objectives We tested the effectiveness of oral fluconazole, griseofulvin, itraconazole and terbinafine in chronic and chronic relapsing tinea corporis, tinea cruris and tinea faciei in an investigator‐initiated, randomized, pragmatic trial. Methods Two hundred patients with microscopy‐confirmed tinea were allocated to four groups (50 patients in each group): fluconazole 5 mg kg−1 per day, griseofulvin 10 mg kg−1 per day, itraconazole 5 mg kg−1 per day and terbinafine 7·5 mg kg−1 per day. Allocation was performed by concealed block randomization and the patients were treated for 8 weeks or until cure. Effectiveness was calculated based on intention‐to‐treat analysis. The trial was registered with the Clinical Trials Registry India (CTRI/2017/04/008281). Results At 4 weeks, all drugs were similarly ineffective, with cure rates being 8% or less (P = 0·42). At 8 weeks, the numbers of patients cured were as follows: fluconazole 21 (42%), griseofulvin seven (14%), itraconazole 33 (66%) and terbinafine 14 (28%) (P < 0·001). Itraconazole was superior to fluconazole, griseofulvin and terbinafine (adjusted P ≤ 0·048). Relapse rates after 4 and 8 weeks of cure with the four treatments were not different (P ≥ 0·42). Numbers needed to treat (vs. griseofulvin), calculated on the basis of cure rates at 8 weeks, were as follows: fluconazole 4, itraconazole 2 and terbinafine 8. Conclusions The results show limited effectiveness of all four antifungal drugs. In view of cure rates and the number needed to treat, itraconazole is the most effective drug, followed by fluconazole (daily), terbinafine and then griseofulvin, in chronic and chronic relapsing dermatophytosis in India. What is already known about this topic? Oral antifungal drugs are considered to have a high cure rate in tinea corporis, tinea cruris and tinea faciei. Unprecedented changes have been noticed in the last few years in India in the morphology, course and treatment responsiveness of tinea; however, data about the effectiveness of oral antifungals are lacking. What does this study add? Our results show limited effectiveness of four oral antifungal drugs (fluconazole, griseofulvin, itraconazole and terbinafine) in the current epidemic of altered dermatophytosis in India. Among the four drugs tested, oral itraconazole is the most effective. Linked Comment: Elewski. Br J Dermatol 2020; 183:798–799.

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“…[ 10 ] and Kumar et al . [ 11 ] reported male:female ratio 1.86:1 and 1.36:1, respectively, in patients with tinea infection. The predominance of males is usually thought to be a result of increased physical activity and thus increased perspiration.…”

Section: Discussionmentioning

confidence: 99%

Relapse after oral terbinafine therapy in dermatophytosis: A clinical and mycological study

et al. 2016

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Background:The incidence of recurrent tinea infections after oral terbinafine therapy is on the rise.Aim:This study aims to identify the appearance of incomplete cure and relapse after 2-week oral terbinafine therapy in tinea corporis and/or tinea cruris.Materials and Methods:A total of 100 consecutive patients clinically and mycologically diagnosed to have tinea corporis and/or tinea cruris were included in the study. The enrolled patients were administered oral terbinafine 250 mg once daily for 2 weeks. All clinically cured patients were then followed up for 12 weeks to look for any relapse/cure.Results:The common dermatophytes grown on culture were Trichophyton rubrum and Trichophyton tonsurans in 55% and 20% patients, respectively. At the end of 2-week oral terbinafine therapy, 30% patients showed a persistent disease on clinical examination while 35% patients showed a persistent positive fungal culture (persisters) at this time. These culture positive patients included all the clinically positive cases. Rest of the patients (65/100) demonstrated both clinical and mycological cure at this time (cured). Over the 12-week follow-up, clinical relapse was seen in 22 more patients (relapse) among those who had shown clinical and mycological cure at the end of terbinafine therapy. Thus, only 43% patients could achieve a long-term clinical and mycological cure after 2 weeks of oral terbinafine treatment. Majority of the relapses (16/22) were seen after 8 weeks of completion of treatment. There was no statistically significant difference in the body surface area involvement or the causative organism involved between the cured, persister, or relapse groups.Conclusions:Incomplete mycological cure as well as relapse is very common after standard (2-week) terbinafine therapy in our patients of tinea cruris/corporis.

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A comparative study of mycological efficacy of terbinafine and fluconazole in patients of tinea corporis

Cited by 6 publications

References 7 publications

Prescription Audit of Anti-fungal Treatment of Dermatophytoses in the Dermatology Out Patient Department of a Tertiary Care Hospital

Prescription Audit of Anti-fungal Treatment of Dermatophytoses in the Dermatology Out Patient Department of a Tertiary Care Hospital

Limited effectiveness of four oral antifungal drugs (fluconazole, griseofulvin, itraconazole and terbinafine) in the current epidemic of altered dermatophytosis in India: results of a randomized pragmatic trial*

Relapse after oral terbinafine therapy in dermatophytosis: A clinical and mycological study

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