What are the oral medication treatment options for Tinea pedis (Athlete's foot)?

From the Guidelines

Oral antifungal medications for Tinea pedis (Athlete's foot) include terbinafine (Lamisil) and itraconazole (Sporanox), with terbinafine being the preferred first-line treatment due to its higher efficacy and lower risk of adverse effects 1. When considering oral medication treatment options for Tinea pedis, it is essential to weigh the potential benefits and risks of each medication.

• Terbinafine is typically prescribed at a dose of 250 mg per day for 2-6 weeks, depending on the severity of the infection 1.
• Itraconazole is usually taken as 200 mg per day for 1-2 weeks, although it can also be given as pulse therapy 1.
• Fluconazole may be considered as an alternative, but its use is generally reserved for patients who are unable to tolerate terbinafine or itraconazole 1. It is crucial to note that oral antifungal medications are typically reserved for severe infections, infections that do not respond to topical treatments, or cases involving multiple areas or the toenails.
• Patients taking oral antifungals should be advised to keep their feet clean and dry, wear breathable footwear, change socks daily, and avoid walking barefoot in public areas to prevent reinfection.
• Potential side effects of oral antifungals include headache, stomach upset, and rarely, liver problems, so liver function tests may be required before and during treatment 1.
• Patients should inform their doctor about other medications they are taking to avoid drug interactions. Overall, the choice of oral antifungal medication for Tinea pedis should be based on the individual patient's needs and medical history, with terbinafine being the preferred first-line treatment due to its efficacy and safety profile 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Accurate diagnosis of the infecting organism is essential... tinea pedis, 4 to 8 weeks; In some forms of tinea pedis, yeasts and bacteria may be involved as well as dermatophytes. Griseofulvin will not eradicate these associated bacterial or yeast infections. Adults: 0. 5 g daily (125 mg four times a day, 250 mg twice a day, or 500 mg/day). Pediatric patients (older than 2 years): A dosage of 10 mg/kg daily is usually adequate INDICATIONS AND USAGE Griseofulvin oral suspension, USP is indicated for the treatment of dermatophyte infections of the skin not adequately treated by topical therapy, hair and nails, namely: ... Tinea pedis

The oral medication treatment option for Tinea pedis (Athlete's foot) is Griseofulvin (PO). The recommended dosage for adults is 0.5 g daily, and for pediatric patients older than 2 years, it is 10 mg/kg daily. The treatment period is typically 4 to 8 weeks. It is essential to note that Griseofulvin will not eradicate associated bacterial or yeast infections that may be involved in some forms of Tinea pedis 2 2.

From the Research

Oral Medication Treatment Options for Tinea Pedis

The following oral medications have been studied as treatment options for Tinea pedis:

• Terbinafine: shown to be more effective than griseofulvin in curing infection 3, 4, 5, 6
• Itraconazole: effective compared to placebo, but no significant difference was detected between itraconazole and terbinafine 3, 4, 5, 6
• Griseofulvin: less effective than terbinafine, but no significant difference was detected between griseofulvin and ketoconazole 3, 4, 5, 6
• Fluconazole: no significant difference was detected between fluconazole and itraconazole, or between fluconazole and ketoconazole 3, 4, 5, 6
• Ketoconazole: no significant difference was detected between ketoconazole and griseofulvin, or between ketoconazole and fluconazole 3, 4, 5, 6

Efficacy of Oral Medications

Studies have shown that:

• Terbinafine has a pooled risk ratio of 2.26 (95% confidence interval 1.49 to 3.44) in favor of its ability to cure infection compared to griseofulvin 3, 4
• Terbinafine and itraconazole are effective compared to placebo, with risk ratios of 24.54 (95% confidence interval 1.57 to 384.32) and 6.67 (95% confidence interval 2.17 to 20.48), respectively 3, 4
• Adverse effects, particularly gastrointestinal effects, have been reported for all drugs 3, 4, 5, 6

Study Limitations

Many of the studies had small sample sizes and poor reporting of information, which limited the ability to make a clear "Risk of bias" assessment 3, 4. Only one trial was at low risk of bias overall 3, 4.