Widespread resistance to conventional doses of antifungals with increasing clinical failure rates warrants the search for an effective first-line antifungal drug that brings about rapid clinical and mycological cure in Tinea corporis and Tinea cruris. Terbinafine resistance when given in the standard conventional 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.

Although resistance to Terbinafine in Dermatophytosis is not common in clinical practice, it has been reported in clinical isolates by few authors. Mukherjee et al. in 2003 reported first confirmed report of Terbinafine resistance in dermatophytes. Majid et al. year? in their study reported that at the end of 12 weeks, there were only 43 cases out of the total 100 cases enrolled who were able to maintain a long-term clinical and mycological cure after 2 weeks of oral Terbinafine treatment. Authors concluded that incomplete mycological cure as well as relapse was very common after standard (2-week) Terbinafine therapy in patients of tinea cruris/corporis.

One of the principle mechanisms of antifungal resistance is decrease in effective drug concentration, [13] which in case of Terbinafine is quite known feature following standard dosing regimen of 250 mg daily due to extensive accumulation in skin and adipose tissue. This clearly shows that the current standard Terbinafine therapy with 250 mg/day dose is not sufficient in current scenario where fungal resistance is further aggravated by increased use, inappropriate prescribing and over the counter sale of antifungal agents.

Even though there is no clear evidence as to what strategy should be used to best avoid resistance, the most commonly suggested measures in the past include prudent use of antifungals and appropriate dosing with special emphasis on avoiding treatment with low antifungal dosage.

Using higher dosages of Terbinafine thus seems useful strategy in countering these problems. Dolton et al. in their study reported that higher dose of Terbinafine was associated with highest trough and peak concentrations and area under the curve values in plasma which in turn were associated with lower minimum inhibitory concentration values and higher antifungal activity. We conducted this survey to find out the effectiveness of Terbinafine using higher dose and standard dose, 500 mg and 250mg once/day in patients with Dermatophytosis.

There has been taken 60 patients for our study. Where 30 patients try Terbinafine 250mg and other 30 patients try 500mg. According to the age distribution of the two groups there the highest number, 31 (51.67%) was found in 36-45 years’ age group on that 15(50.00%) patients in group-I and 16(53.33%) in group-II. It was followed by 21 (35%) from 26-35 age group, where 10(33.33%) from group-I and 11(36.67%) from group-II. Again 5(8.33%) in ≥45 years age group where 3(10.00%) from group-I and 2(6.67%) from group-II and 3(5.00%) in ≤25 where 2(6.67%) from group-I and 1(3.33%) from group-II. The improvement rate of Terbinafine 250mg and 500mg showed in the study. On that the improvement rate of Terbinafine 500mg is better than Terbinafine 250mg. From the study after 2 weeks the improvement rate of group II (Terbinafine 500mg) was 11.2% and the other group I (Terbinafine 250mg) was 6.06%. Again after 4 weeks group II (Terbinafine 500mg) was 88.34% and the other group I (Terbinafine 250mg) was 57.43%. Now Dermatophytosis Area Severity Index-comparison (DASI) within two groups was recorded as DASI baseline group I (16±1.17) and group II (17.32±1.12). P value of group I was 0.0342 and group II was 0.0473. In our survey, Terbinafine given for 4 weeks was found to be most effective treatment strategy against superficial Dermatophytosis.

The most common side effects with Terbinafine are gastric upset, headache, altered taste, altered liver function tests and rash; rarely, it can cause blood dyscrasias and hepatitis. However, in our study, minor side effects such as nausea, bloating sensation, headache, and taste disturbances were seen. The results of our study suggest that Terbinafine 500mg is more successful than Terbinafine 250mg in fungal cure.

Introduction: Dermatophytosis is the most common fungal infections globally. Terbinafine is considered to have good potency against dermaphytes, but resistance to Terbinafine is on the rise.

Objectives: The objective of this study was to do comparative study of Terbinafine in conventional dose versus double dose in treatment of Dermatophytosis.

Methods: This cross-sectional comparison study conducted in the outpatient department of Cumilla Medical College Hospital, Cumilla, Bangladesh during the period from July 2018 to June 2019. In this randomized comparative study, patients of Tinea cruris and Tinea corporis were randomly divided into two groups of 87 each and were given oral Terbinafine in conventional dose (Group I) and oral Terbinafine in double dose (Group II) for 4 weeks. The scores and percentage changes measured from pruritus, scaling, and erythema were evaluated at 2^nd and 4^th weeks.

Result: In total of 60 patients from both the groups completed the study. In this study it was found the Improvement rate of terbinafine double dose in higher 11.1 and 88.34 then the single dose.

Conclusion: This study indicates that Terbinafine in a dose of 500 mg (double dose) given once daily was more effective than Terbinafine 250mg in the treatment of patients with Dermatophytosis.