From the Guidelines
If your fungal infection has returned after initial improvement with terbinafine, you should consult your healthcare provider promptly to extend your treatment course, as many fungal infections require longer therapy than just two weeks. Terbinafine typically requires 2-6 weeks for skin infections and up to 12 weeks for nail infections to completely eradicate the fungus, as stated in the British Association of Dermatologists' guidelines for the management of onychomycosis 2014 1. Your provider might increase your dosage, switch to a different antifungal medication like itraconazole or fluconazole, or recommend combination therapy. While waiting for your appointment, continue using the medication as prescribed and maintain good hygiene practices -
- keep the affected area clean and dry,
- avoid sharing personal items,
- wear breathable fabrics, and
- change socks daily if it's a foot infection. Fungal infections often recur because treatment was stopped too early, allowing resistant fungal spores to survive and multiply, as noted in the guidelines for treatment of onychomycosis 1. Complete eradication requires consistent treatment even after symptoms improve, as fungi can remain viable beneath the surface. It's also essential to take preventive measures to avoid reinfection, such as wearing protective footwear, applying antifungal powders, and keeping your nails short, as recommended in the British Association of Dermatologists' guidelines 1. Additionally, considering the high recurrence rates of onychomycosis, which can range from 40-70% 1, it's crucial to work closely with your healthcare provider to determine the best course of action for your specific case. The choice between terbinafine and itraconazole should be based on their efficacy and tolerability, with terbinafine being considered the first choice due to its higher efficacy, as shown in a multicentre, randomized trial involving 508 subjects 1.
From the FDA Drug Label
In the first toenail study, for patients evaluated at least six months after achieving clinical cure and at least one year after completing terbinafine therapy, the clinical relapse rate was approximately 15%
The FDA drug label does not provide direct guidance on what to do if a fungal infection returns after initial improvement with terbinafine. However, it does mention a clinical relapse rate of approximately 15% in patients who achieved clinical cure after completing terbinafine therapy.
- Clinical relapse is a possibility after treatment with terbinafine.
- The label does not specify the best course of action in case of relapse.
- It is recommended to consult a physician for further guidance on how to manage the returned fungal infection. 2 2
From the Research
Fungal Infection Treatment with Terbinafine
- If a fungal infection returns after initial improvement with terbinafine, it may be necessary to reassess the treatment plan 3, 4.
- Terbinafine is an effective antifungal medication for treating various types of fungal infections, including tinea corporis and tinea cruris 5, 3, 4.
- The standard treatment duration for terbinafine can vary depending on the type and severity of the infection, but it is typically taken for 1-4 weeks 3, 4, 6.
Possible Reasons for Treatment Failure
- Insufficient treatment duration or dosage may contribute to the return of the fungal infection 3, 4, 6.
- Resistance to terbinafine or other antifungal medications can also lead to treatment failure 6.
- Inadequate diagnosis or misidentification of the fungal infection may result in ineffective treatment 3, 4.
Alternative Treatment Options
- Other antifungal medications, such as itraconazole or fluconazole, may be considered as alternative treatments for fungal infections 4, 6.
- Topical antifungal creams or ointments, such as sertaconazole or clotrimazole, can also be effective in treating fungal infections 3, 7.
- Combination therapy, using multiple antifungal medications or treatments, may be necessary in some cases to achieve optimal results 3, 6.