From the Guidelines
Oral antifungal medications, such as terbinafine and griseofulvin, are the primary treatment options for fungal skin infections, with the specific medication and dosage depending on the type and severity of the infection, as well as the patient's weight and other factors 1.
Treatment Options
- Terbinafine is often used to treat infections caused by Trichophyton species, with a typical dosage of 250mg daily for 2-4 weeks for patients weighing over 40kg 1.
- Griseofulvin is commonly used to treat infections caused by Microsporum species, with a typical dosage of 15-20mg/kg per day for 6-8 weeks for patients weighing under 50kg, and 1g per day for patients weighing over 50kg 1.
- Itraconazole is also an option, particularly for patients who are not responding to other treatments, with a typical dosage of 50-100mg per day for 4 weeks 1.
Considerations
- The choice of medication should be guided by the causative dermatophyte and local epidemiology 1.
- Treatment duration and dosage may vary depending on the specific infection and patient factors, such as weight and age 1.
- Patients should be monitored for potential side effects, particularly liver function abnormalities, and drug interactions should be carefully considered before prescribing 1.
Additional Measures
- In cases of treatment failure, it is essential to consider factors such as lack of compliance, suboptimal absorption of the drug, relative insensitivity of the organism, and reinfection 1.
- Completing the full prescribed course of treatment is crucial to prevent recurrence, even if symptoms improve earlier 1.
From the FDA Drug Label
Terbinafine tablets are a prescription medicine used to treat fungal infections of the fingernails and toenails (onychomycosis)
DIFLUCAN should be administered with caution to patients with liver dysfunction. DIFLUCAN has been associated with rare cases of serious hepatic toxicity, including fatalities primarily in patients with serious underlying medical conditions
Fluconazole is designated chemically as 2,4-difluoro-α,α1-bis(1H-1,2,4-triazol-1-ylmethyl) benzyl alcohol with an empirical formula of C13H12F2N6O and molecular weight of 306. 3.
The oral treatment options for fungal skin infections include:
- Terbinafine (PO): used to treat fungal infections of the fingernails and toenails (onychomycosis) 2
- Fluconazole (PO): can be used to treat various fungal infections, but its use for skin infections is not explicitly stated in the provided labels, however, it can be used for certain types of fungal infections 3 3 Key considerations:
- Liver function should be monitored when using these medications, especially in patients with pre-existing liver conditions
- Patients should be advised to report any symptoms of liver problems, such as nausea, poor appetite, or yellowing of the skin or eyes
- These medications can cause serious side effects, including liver problems, allergic reactions, and blood clotting problems, and should be used with caution.
From the Research
Oral Treatment Options for Fungal Skin Infections
The following oral treatments are available for fungal skin infections:
- Terbinafine: an allylamine antifungal agent with fungicidal activity against a wide variety of dermatophytes, moulds, and certain dimorphic fungi, and fungistatic activity against Candida albicans 4
- Itraconazole: an antifungal drug that can be used alone or in combination with terbinafine for the treatment of recalcitrant dermatophytosis 5
Efficacy of Oral Terbinafine
Oral terbinafine has been shown to be effective in the treatment of:
- Superficial dermatophyte infections such as onychomycosis, tinea pedis, and tinea corporis/cruris, with mycological cure rates of > 80% 4
- Tinea capitis in children, with a dosage range of 62.5 to 250 mg/day for 4 weeks 4
- Fungal skin infections, with observed improvements in symptoms such as erythema, blistering, exudation, scaling, and pruritus 6
Combination Therapy
Combination therapy with terbinafine and itraconazole has been shown to have a higher clinical and mycological cure rate compared to monotherapy with either drug alone 5
Safety and Tolerability
Oral terbinafine is generally well tolerated, with adverse effects such as gastrointestinal symptoms and minor skin rashes reported in 5.3% of patients 6 Terbinafine has a relatively low potential for drug interactions, making it a safe treatment option for fungal skin infections 4