What is the best medication for athlete's foot (tinea pedis)?

From the Guidelines

The best medication for athlete's foot (tinea pedis) is typically an over-the-counter topical antifungal cream containing terbinafine (Lamisil), which has been shown to have a mycological cure rate of approximately 94% when applied daily for 1 week 1. To effectively treat athlete's foot, apply the cream to the affected areas twice daily for 1-2 weeks, continuing for at least one week after symptoms disappear to ensure complete eradication of the fungus. Some key points to consider when treating athlete's foot include:

• For mild to moderate cases, terbinafine 1% cream is often most effective, working faster than other options with results sometimes seen within days.
• For severe or persistent infections that don't respond to over-the-counter treatments, prescription-strength medications may be necessary, such as oral terbinafine (250mg daily for 2 weeks) or itraconazole.
• While treating the infection, keep feet clean and dry, wear breathable footwear, change socks daily, and avoid walking barefoot in public areas to prevent reinfection.
• These antifungal medications work by disrupting the fungal cell membrane or inhibiting ergosterol synthesis, which is essential for fungal cell survival, effectively killing the dermatophyte fungi that cause athlete's foot. It's also important to note that athlete's foot can be prevalent in warm, humid environments and affects men more than women, with the predominant causes being T rubrum and T mentagrophytes 1. Additionally, to prevent reinfection, it's essential to wear protective footwear, apply antifungal powders, and keep nails short 1.

From the FDA Drug Label

Ultramicrosize griseofulvin tablets are indicated for the treatment of the following ringworm infections; tinea corporis (ringworm of the body), tinea pedis (athlete’s foot), tinea cruris (ringworm of the groin and thigh), tinea barbae (barber’s itch), tinea capitis (ringworm of the scalp), and tinea unguium (onychomycosis, ringworm of the nails), when caused by one or more of the following genera of fungi: Trichophyton rubrum, Trichophyton tonsurans, Trichophyton mentagrophytes, Trichophyton interdigitalis, Trichophyton verrucosum, Trichophyton megnini, Trichophyton gallinae, Trichophyton crateriform, Trichophyton sulphureum, Trichophyton schoenleini, Microsporum audouini, Microsporum canis, Microsporum gypseum and Epidermophyton floccosum

• Griseofulvin is a medication that can be used to treat tinea pedis (athlete's foot), as indicated in the drug label 2.
• The drug label specifies that the type of fungi responsible for the infection should be identified prior to therapy, and that griseofulvin is not justified in minor or trivial infections that will respond to topical agents alone.
• Key points to consider when using griseofulvin for athlete's foot include:
  • The infection must be caused by a susceptible fungus
  • The drug may not be effective for all types of fungal infections
  • Topical agents may be sufficient for minor or trivial infections

From the Research

Best Medication for Athlete's Foot

The best medication for athlete's foot (tinea pedis) can vary depending on the severity and type of infection. Here are some options:

• Oral treatments:
  • Terbinafine is more effective than griseofulvin in treating tinea pedis, with a pooled risk ratio of 2.26 in favor of terbinafine 3
  • Terbinafine and itraconazole are more effective than no treatment, with risk ratios of 24.54 and 6.67, respectively 3
• Topical treatments:
  • Terbinafine 1% cream is more effective than clotrimazole 1% cream, with mycological cure rates of 93.5% and 73.1%, respectively 4
  • Ciclopirox gel 0.77% is an effective treatment for moderate interdigital tinea pedis, with a treatment success rate of 60% 5
  • Allylamines, such as terbinafine, are more effective than azoles in treating athlete's foot, with a risk ratio of treatment failure of 0.63 in favor of allylamines 6

Comparison of Medications

Here is a comparison of the medications mentioned:

• Terbinafine: effective in treating tinea pedis, with a high mycological cure rate and a low risk of adverse effects 3, 4
• Griseofulvin: less effective than terbinafine in treating tinea pedis, with a higher risk of adverse effects 3, 7
• Itraconazole: effective in treating tinea pedis, with a high mycological cure rate and a low risk of adverse effects 3, 7
• Clotrimazole: less effective than terbinafine in treating tinea pedis, with a lower mycological cure rate 4
• Ciclopirox: effective in treating moderate interdigital tinea pedis, with a high treatment success rate 5
• Allylamines: more effective than azoles in treating athlete's foot, with a lower risk of treatment failure 6