From the Guidelines
Terbinafine is the most effective antifungal for treating fungal infections on the feet, including onychomycosis and athlete's foot, due to its high cure rates and superiority over other treatments like itraconazole 1. When treating fungal infections on the feet, it is essential to choose the right antifungal medication to ensure effective treatment and prevent recurrence.
- Topical antifungals like terbinafine, clotrimazole, and tolnaftate are available over-the-counter and can be applied to clean, dry feet twice daily for 1-4 weeks.
- For severe or persistent infections, prescription-strength medications like oral terbinafine or itraconazole may be necessary, with oral terbinafine being the preferred choice due to its higher cure rates 1.
- In addition to medication, keeping feet clean and dry, wearing breathable footwear, changing socks daily, and avoiding walking barefoot in public areas can help prevent the spread of fungal infections.
- Terbinafine has been shown to have a mycological cure rate of approximately 94% when used to treat T cruris, making it a highly effective treatment option 1.
- It is crucial to note that treatment should not be commenced before mycological confirmation of infection, and dermatophytes are the most common causal organisms, making terbinafine an ideal choice 1.
From the FDA Drug Label
Directions • adults and children 12 years and older o use the tip of the cap to break the seal and open the tube o wash the affected skin with soap and water and dry completely before applying o for athlete's foot wear well-fitting, ventilated shoes. Change shoes and socks at least once daily. ▪ between the toes only: apply twice a day (morning and night) for 1 week or as directed by a doctor. ▪ on the bottom or sides of the foot: apply twice a day (morning and night) for 2 weeks or as directed by a doctor. INDICATIONS AND USAGE Naftin® Gel, 1% is indicated for the topical treatment of tinea pedis, tinea cruris and tinea corporis caused by the organisms Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton tonsurans1 and Epidermophyton floccosum.
The best antifungal for feet is terbinafine (TOP) or naftifine (TOP), as both are indicated for the treatment of tinea pedis (athlete's foot) 2 3.
- Terbinafine (TOP) is applied twice a day for 1 week between the toes or 2 weeks on the bottom or sides of the foot.
- Naftifine (TOP) is indicated for the topical treatment of tinea pedis, but the application frequency is not specified in the provided text.
From the Research
Antifungal Treatments for Feet
- The most effective antifungal treatments for feet, specifically for onychomycosis, include itraconazole and terbinafine, as demonstrated in a study published in 2001 4.
- These agents have shown efficacy against Scopulariopsis brevicaulis, a common non-dermatophyte mould that can cause onychomycosis.
- Topical treatments, such as allylamines (naftifine and terbinafine) and azoles (bifonazole, clotrimazole, econazole nitrate, miconazole nitrate, sulconazole nitrate, and tioconazole), have also been found to be effective in treating athlete's foot, as reported in systematic reviews published in 2006 5 and 2009 6.
- More recent antifungal drugs, including efinaconazole and tavaborole, have been approved for the treatment of onychomycosis, offering additional options for patients, as discussed in a 2016 review 7.
Safety and Efficacy
- Itraconazole and terbinafine have been shown to be safe and effective in the treatment of onychomycosis, with minimal adverse effects reported 4.
- Griseofulvin, on the other hand, has been found to be ineffective against Scopulariopsis brevicaulis, and ketoconazole is not recommended due to its potential for adverse effects 4.
- The choice of antifungal treatment should be based on the specific type of fungal infection, as well as the patient's medical history and preferences.