From the FDA Drug Label
Accurate diagnosis of infecting organism is essential. Identification should be made either by direct microscopic examination of a mounting of infected tissue in a solution of potassium hydroxide or by culture on an appropriate medium Medication must be continued until the infecting organism is completely eradicated as indicated by appropriate clinical or laboratory examination. Representative treatment periods are tinea capitis, 4 to 6 weeks; tinea corporis, 2 to 4 weeks; tinea pedis, 4 to 8 weeks; Concomitant use of appropriate topical agents is usually required, particularly in treatment of tinea pedis. For those fungal infections more difficult to eradicate, such as tinea pedis and tinea unguium, a divided dose of 750 mg is recommended.
The treatment for recurrent tinea pedis involves:
- Oral medication: griseofulvin (PO) with a divided dose of 750 mg per day 1
- Topical treatment: concomitant use of appropriate topical agents, such as clotrimazole (TOP), is usually required 1, 2
- Treatment duration: at least 4 to 8 weeks to ensure the infecting organism is completely eradicated 1
- General measures: observation of general measures in regard to hygiene to control sources of infection or reinfection 1
From the Research
The treatment for recurrent tinea pedis should start with a topical antifungal cream such as terbinafine 1% (Lamisil) applied twice daily for 2-4 weeks, as it has been shown to be highly effective in achieving mycological cure and effective treatment 3. When considering the treatment for recurrent tinea pedis, it is essential to prioritize the most recent and highest quality study available. The study published in the BMJ (Clinical research ed.) in 1993 3 compared the efficacy and safety of terbinafine 1% cream and clotrimazole 1% cream in the treatment of tinea pedis, demonstrating that terbinafine was more effective in achieving mycological cure and effective treatment. Some key points to consider when treating recurrent tinea pedis include:
- The use of topical antifungal creams such as terbinafine 1% or clotrimazole 1% for 2-4 weeks 4, 3
- The consideration of oral antifungal medications such as terbinafine 250mg daily for 2 weeks or itraconazole 200mg twice daily for 1 week for severe or resistant cases 5
- The importance of preventive measures such as keeping feet clean and dry, wearing breathable footwear, and using antifungal powder in shoes to prevent recurrence 6, 7
- The potential need to consider underlying conditions such as diabetes or immunosuppression that may contribute to treatment resistance 7