Evaluation of efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis

Sharma, Priyanka; Bhalla, Mala; Thami, Gurvinder P.; Chander, Jagdish

doi:10.1080/09546634.2019.1612835

Cited by 37 publications

(43 citation statements)

References 18 publications

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“…Sharma et al in their study reported only 50% cure rate with 3 weeks 200mg/day itraconazole therapy. 12 Similar decrease in clinical efficacy of amorolfine is evident from recent report by Das et al who reported only 26.09% complete cure rate with amorolfine which was lower as compared to previous studies showing variable cure rates of 80 -90%. 13 Hence combination therapy seems more useful in management of patients with multi-site tinea infections.…”

Section: Discussionsupporting

confidence: 65%

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Effectiveness and safety of combination of Itraconazole and Amorolfine in management of patients with recalcitrant multi-site dermatophytosis who failed previous combination antifungal therapy

Vishwanath¹,

Londhe²,

Tare³

et al. 2020

IJCED

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There is alarming rise in cases of dermatophytosis in India. Standard treatment recommendations are no longer working. Combination of topical and systemic antifungal drugs is one of the most frequently used treatment strategy. Materials and Methods: This was an open label, prospective, interventional, non-comparative study. Effectiveness endpoints were percentage of patients achieving complete cure, clinical cure and mycological cure at the end of the treatment period from baseline. Safety was assessed by analyzing the AEs and monitoring of liver function tests. Results: 66 patients were included in the study. 75.75%, 86.36% and 81.8% patients achieved complete cure, clinical cure and mycological cure respectively at the end of the study period. There was improvement in each symptom during study duration as observed during each follow up visit on week 2, 4 and 6. Total of 10.60% reported 1 or more drug related AE. Nausea was most common side effect followed by vomiting, headache and edema of face. All the AEs were mild in nature and resolved during study. Conclusion:To conclude the result of this study shows that the combination therapy of oral itraconazole and topical amorolfine represents an improved treatment strategy for patients with recalcitrant multisite tinea infections.

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Section: Discussionsupporting

confidence: 65%

“…13,17 Similarly Sharma et al in their study reported mycological cure rate of 50% for itraconazole monotherapy. 12 This clearly indicates that the combination therapy with amorolfine and itraconazole is better than either therapy alone in management of recalcitrant multisite tinea infection.…”

Section: Discussionmentioning

confidence: 97%

Effectiveness and safety of combination of Itraconazole and Amorolfine in management of patients with recalcitrant multi-site dermatophytosis who failed previous combination antifungal therapy

Vishwanath¹,

Londhe²,

Tare³

et al. 2020

IJCED

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“…isolates worldwide [ 19 , 34 , 35 ]. Although there are no well-established guidelines for the dosage and duration of systemic therapy in patients with fungal infections [ 36 ], terbinafine should be the first-line treatment, as itraconazole is more prone to adverse effects [ 37 ]. However, to the best of our knowledge, terbinafine resistance in T. mentagrophytes isolates has already been reported in Asian and European countries, including India [ 21 , 23 , 25 , 26 ], Switzerland [ 22 , 27 ], Japan [ 24 ], Finland [ 38 ], Denmark [ 28 ], Bahrain [ 29 ], Iran [ 39 ], and Russia [ 40 ] (Fig.…”

Section: Discussionmentioning

confidence: 99%

Intrinsic resistance to terbinafine among human and animal isolates of Trichophyton mentagrophytes related to amino acid substitution in the squalene epoxidase

et al. 2020

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Background Dermatomycoses are the most common fungal infections in the world affecting a significant part of the human and animal population. The majority of zoophilic infections in humans are caused by Trichophyton mentagrophytes. Currently, the first-line drug for both oral and topical therapy is terbinafine. However, an increasing number of cases that are difficult to be cured with this drug have been noted in Europe and Asia. Resistance to terbinafine and other allylamines is very rare and usually correlated with point mutations in the squalene epoxidase gene resulting in single amino acid substitutions in the enzyme, which is crucial in the ergosterol synthesis pathway. Purpose Here, we report terbinafine-resistant T. mentagrophytes isolates among which one was an etiological factor of tinea capitis in a man and three were obtained from asymptomatic foxes in Poland. Methods We used the CLSI protocol to determine antifungal susceptibility profiles of naftifine, amphotericin B, griseofulvin, ketoconazole, miconazole, itraconazole, voriconazole, and ciclopirox. Moreover, the squalene epoxidase gene of the terbinafine-resistant strains was sequenced and analysed. Results In the genomes of all four resistant strains exhibiting elevated MICs to terbinafine (16 to 32 µg/ml), single-point mutations leading to Leu393Phe substitution in the squalene epoxidase enzyme were revealed. Among the other tested substances, a MIC50 value of 1 µg/ml was shown only for griseofulvin. Conclusion Finally, our study revealed that the terbinafine resistance phenomenon might not be acquired by exposure to the drug but can be intrinsic. This is evidenced by the description of the terbinafine-resistant strains isolated from the asymptomatic animals.

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“… 24 , 52 , 84 Randomized control trials support the efficacy of systemic treatment with oral antifungal agents. 116 , 117 Oral antifungal agents used for the treatment of tinea corporis include itraconazole (children: 3–5 mg/kg/day [maximum 200 mg/day]; adults: 200 mg/day), fluconazole (children: 6 mg/kg once weekly [maximum: 200 mg once weekly]; adults: 200 mg once weekly), terbinafine granules (children: <25 kg, 125 mg/day; 25–35 kg, 187.5 mg/day; >35 kg, 250 mg/day), and terbinafine tablets (children: 10–20 kg, 62.5 mg/day; 21–40 kg, 125 mg/day; >40 mg, 250 mg/day; adults: 250 mg/day). 2 , 24 , 56 , 118 The duration of treatment varies, depending on the response.…”

Section: Treatmentmentioning

confidence: 99%

Tinea corporis: an updated review

Leung¹,

Lam²,

Leong³

et al. 2020

DIC

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Background Tinea corporis is a common fungal infection that mimics many other annular lesions. Physicians must familiarize themselves with this condition and its treatment. Objective This article aimed to provide a narrative updated review on the evaluation, diagnosis, and treatment of tinea corporis. Methods A PubMed search was performed with Clinical Queries using the key term ‘tinea corporis.’ The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies, and reviews. The search was restricted to the English language. The information retrieved from the mentioned search was used in the compilation of the present article. Results Tinea corporis typically presents as a well-demarcated, sharply circumscribed, oval or circular, mildly erythematous, scaly patch or plaque with a raised leading edge. Mild pruritus is common. The diagnosis is often clinical but can be difficult with prior use of medications, such as calcineurin inhibitors or corticosteroids. Dermoscopy is a useful and non-invasive diagnostic tool. If necessary, the diagnosis can be confirmed by microscopic examination of potassium hydroxide wet-mount preparations of skin scrapings from the active border of the lesion. Fungal culture is the gold standard to diagnose dermatophytosis especially if the diagnosis is in doubt and results of other tests are inconclusive or the infection is widespread, severe, or resistant to treatment. The standard treatment of tinea corporis is with topical antifungals. Systemic antifungal treatment is indicated if the lesion is multiple, extensive, deep, recurrent, chronic, or unresponsive to topical antifungal treatment, or if the patient is immunodeficient. Conclusion The diagnosis of tinea corporis is usually clinical and should pose no problem to the physician provided the lesion is typical. However, many clinical variants of tinea corporis exist, rendering the diagnosis difficult especially with prior use of medications, such as calcineurin inhibitors or corticosteroids. As such, physicians must be familiar with this condition so that an accurate diagnosis can be made and appropriate treatment initiated.

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Evaluation of efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis

Cited by 37 publications

References 18 publications

Effectiveness and safety of combination of Itraconazole and Amorolfine in management of patients with recalcitrant multi-site dermatophytosis who failed previous combination antifungal therapy

Effectiveness and safety of combination of Itraconazole and Amorolfine in management of patients with recalcitrant multi-site dermatophytosis who failed previous combination antifungal therapy

Intrinsic resistance to terbinafine among human and animal isolates of Trichophyton mentagrophytes related to amino acid substitution in the squalene epoxidase

Tinea corporis: an updated review

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