From the FDA Drug Label
Directions • adults and children 12 years and older
▪ 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.
Uses • cures most athlete's foot (tinea pedis)
The recommended treatment for athlete's foot is to apply terbinafine twice a day for 1 week between the toes or 2 weeks on the bottom or sides of the foot, or as directed by a doctor 1. However, there is no information provided about HIV medications or antiretroviral therapy in the given drug labels. The FDA drug label does not answer the question.
From the Research
For patients with HIV on antiretroviral therapy, the recommended treatment for athlete's foot (tinea pedis) is topical antifungal medications, including clotrimazole 1% cream, miconazole 2% cream, or terbinafine 1% cream applied twice daily for 2-4 weeks, as supported by the most recent and highest quality study 2.
Key Considerations
- The treatment approach should prioritize topical antifungal medications as the first line of treatment.
- For more severe or resistant cases, oral antifungal medications such as itraconazole may be considered, given its superior effectiveness as shown in the study 2.
- It is crucial to check for potential drug interactions with the patient's specific antiretroviral medications, especially when prescribing oral antifungals like itraconazole, due to its potential impact on the cytochrome P450 system.
- Good foot hygiene practices, including keeping feet dry, changing socks daily, wearing breathable footwear, and using antifungal powder in shoes, are essential for preventing recurrence and managing the condition effectively.
- HIV patients may experience more persistent or recurrent infections due to immune compromise, making thorough treatment and preventive measures especially important.
Treatment Options
- Topical antifungal medications:
- Clotrimazole 1% cream
- Miconazole 2% cream
- Terbinafine 1% cream
- Oral antifungal medications (for severe or resistant cases):
- Itraconazole 200mg daily for 1-2 weeks, considering its effectiveness as per the study 2
- Terbinafine 250mg daily for 2 weeks, although its effectiveness may vary as seen in the study 2
Important Precautions
- Check for potential drug interactions with antiretroviral medications.
- Practice good foot hygiene to prevent recurrence.
- Monitor for signs of treatment failure or recurrence, given the potential for limited effectiveness of antifungal drugs as noted in the study 2.