Efficacy of oral Terbinafine vs Itraconazole in treatment of dermatophytic infection of skin
Indian Journal of Pharmacology: Published: May, 2019
Dermatophytic infections are the
common fungal infections aggravated by hot and humid climate. Terbinafine and Itraconazole
are commonly used oral antifungal agents for the same. However, resistance to
these drugs is being seen increasingly when used in the conventional doses and
duration.
In the past, terbinafine was
consistently effective against dermatophytosis with cure rates of >90%
achieved at doses of 250 mg once a day for 2 weeks.
Recently, there has been an
increase in the incidence of terbinafine resistance with increasing numbers of
clinical failures and relapses.
It has been observed recently that
there has been widespread resistance to various antifungal agents used in
conventional dose with an increase in relapse rates prompting a need to find an
effective first-line antifungal drug and appropriate dosage and duration
schedule to achieve maximum results with fewer relapses.
Therefore, this study was designed
to compare the efficacy of terbinafine and itraconazole in increased dosages
and duration in the treatment of tinea corporis and tinea cruris.
TAKE HOME MESSAGE
Terbinafine resistance when given in the standard doses (250 mg
once a day for 2 weeks) is being increasingly seen with partial or no response
to treatment. Antifungal resistance is
due to a decrease in effective drug concentration because of extensive
accumulation of terbinafine in the skin and adipose tissue.
Hence, higher concentration of terbinafine 500 mg/day has seen found to be
more effective.
Itraconazole is a triazole antifungal drug which is also
increasingly being used as a first-line drug for tinea corporis and tinea
cruris, but it is being given for longer periods as compared to before.
It has shown good results in the
treatment of dermatophytosis at doses of 100 mg once a day for 2 weeks and with
200 mg once a day for 7 days.
The results of this study suggest that itraconazole is a better drug than
terbinafine in efficacy and mycological cure.
Although studies on toenail
onychomycosis have found terbinafine to be more effective than itraconazole, we
found the reverse to be true for tinea corporis and tinea cruris.
However, when taken into account
the response rates and total duration of therapy required to have complete
cure, itraconazole fares slightly better over terbinafine, thereby mitigating
the cost difference.
Both the drugs have a similar pharmacokinetic profile. Safety profile was similar in both the groups.
Conclusion
Itraconazole and terbinafine seem
to be equally effective and safe in the treatment of tinea cruris and tinea
corporis.
Itraconazole has higher clinical
and mycological cure rates as compared to terbinafine. Although the cost of
terbinafine is lower, the failure rate is higher and the duration of treatment
required is longer.
Therefore, itraconazole seems to be superior to terbinafine in the treatment of tinea corporis and tinea cruris.
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OBJECTIVES:
Dermatophytic infections are the
common fungal infections aggravated by hot and humid climate. Terbinafine and
itraconazole are commonly used oral antifungal agents for the same. However,
resistance to these drugs is being seen increasingly when used in the
conventional doses and duration. Therefore, this study was designed to compare
the efficacy of terbinafine and itraconazole in increased dosages and duration
in the treatment of tinea corporis and tinea cruris.
MATERIALS AND METHODS:
In this randomized comparative
study, patients of tinea cruris and tinea corporis were randomly divided into
two groups of 160 each and were given oral terbinafine (Group I) and oral
itraconazole (Group II) for 4 weeks. The scores and percentage change in scores
of pruritus, scaling, and erythema were evaluated at 2 and 4 weeks.
RESULTS:
At the end of week 4, mycological
cure was seen in 91.8% after 4 weeks in the itraconazole group as compared to
74.3% of patients in the terbinafine group. There was a significant improvement
in percentage change in pruritus, scaling, and erythema in both the groups from
0 to 4 weeks. On comparing groups, the percentage change was significantly
different in scaling from 0 to 2 weeks (5.4 vs. −4.8) and 2–4 weeks (16.7 vs.
29.6) between Group I and Group II, respectively. Clinical global improvement
was better with itraconazole. Mild adverse effects such as gastrointestinal
upset, headache, and taste disturbances were observed which were comparable in
both the groups.
CONCLUSIONS:
Itraconazole and terbinafine seem
to be equally effective and safe in the treatment of tinea cruris and tinea
corporis.
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