Combination of Terbinafine twice daily and Itraconazole twice in a pulse dose in resistant Tinea infection
International Journal of Research in Dermatology: March,
2022
Tinea caused by trichophyton, microsporum, and epidermophyton is the most common fungal infection affecting 20–25% population globally, with varying geographic distribution.
Due to Bangladesh’s hot and humid climate, there has been a
rampant increase in the
cases of tinea infection and a typical presentation in recent years. The
management of tinea is challenging in Bangladesh and there are reports of using
systemic antifungals at higher doses.
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The study aimed to find
out the effectiveness of systemic terbinafine (250 mg) twice daily and
itraconazole (100 mg) twice in a pulse dose in resistant tinea infection.
The recommended treatment of commonly prescribed
antifungal agents no longer seems to be valid in the current scenario, resulting in treatment failures and
relapses when given in conventional doses and for standard duration.
Moreover, the choice of therapy is further influenced by multiple factors like simultaneous involvement of extensive body area, hair follicles, and a previous history of treatment failures, recurrences, and relapses.
Combination therapy is a
well-established concept of using synergistic and additive effects of two or more drugs to improve therapeutic efficacy and overcome drug resistance.
The combination of systemic terbinafine (250 mg) twice daily and itraconazole (100 mg) twice in a pulse dose therapy may be an effective and safe therapeutic strategy in the management of registrant tinea infection.
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Background: The
management of tinea is challenging in Bangladesh and there are reports of using
systemic antifungals at higher doses. The aim of the study was to find out the
effectiveness of systemic terbinafine (250 mg) twice daily and itraconazole
(100 mg) twice in a pulse dose in resistant tinea infection.
Methods: It
was a prospective, observational study conducted in the department of
dermatology and venereology, Dhaka Dermatology Institute, Dhaka, Bangladesh
from November 2020 to October 2021. Clinically confirmed cases of tinea
corporis et cruris were recruited by random sampling techniques for the study
and followed up for 12 weeks, till the completion of their treatment. Patients
who were pregnant, lactating, non-consensual, as well as those who had a history
of anti-mycotic treatment within 2 weeks prior to baseline visit were excluded
from the study.
Results: A
total of 30 patients were randomly assigned treatment and included in the study. According
to within 4 weeks 11 (36.33%) patients were significantly improved and 19
(63.33%) patients were non-significantly improved, >4 week to till 8 weeks
16 (84.21%) patients were improved significantly and 3 (15.79%) patients were
improved non-significantly and >8 week to till 12 weeks 3 (100%) patients
were improved properly. Mycological cure was achieved in 25 (82.89%) patients,
clinical cure rate was achieved same in 24 (79%) patients and complete cure
rate was achieved 30 (100%) patients.
Conclusions: The combination of systemic terbinafine (250 mg) twice daily and itraconazole (100 mg) twice in a pulse dose therapy may be an effective and safe therapeutic strategy in the management of registrant tinea infection.
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