What is the recommended dosing for terbinafine (antifungal) cream?

Terbinafine Cream Dosing Recommendations

Terbinafine 1% cream should be applied once daily for 1 week for the treatment of most superficial fungal infections including tinea pedis, tinea cruris, and tinea corporis. 1

Dosing Guidelines by Infection Type

Tinea Pedis (Athlete's Foot)

• Recommended regimen: Apply terbinafine 1% cream once daily for 1 week 1, 2
• This short-duration therapy offers significant advantages over other antifungals:
  • Achieves mycological cure rates of approximately 93.5% at 4 weeks 2
  • Significantly more effective than clotrimazole 1% cream applied twice daily for 4 weeks 2
  • Effective treatment rates of 89.7% at both 4 and 6 weeks post-treatment 2

Tinea Cruris (Jock Itch)

• Recommended regimen: Apply terbinafine 1% cream once daily for 1 week 1
• Achieves mycological cure rate of approximately 94% 1
• Approved for children 12 years and older 1

Tinea Corporis (Ringworm)

• Recommended regimen: Apply terbinafine 1% cream once daily for 1-2 weeks 3
• Achieves mycological cure in >80% of patients 3

Mechanism of Action and Efficacy

Terbinafine is an allylamine antifungal with a fungicidal mechanism of action, which explains its effectiveness with shorter treatment durations compared to fungistatic agents 3, 4:

• Inhibits squalene epoxidase, essential for ergosterol biosynthesis in the fungal cell wall 1
• Causes both depletion of ergosterol (fungistatic effect) and accumulation of squalene (fungicidal effect) 1
• Particularly effective against dermatophytes including Trichophyton rubrum and Trichophyton mentagrophytes 1
• Mycological cure rates generally improve after treatment cessation due to its residual effect in tissue 3

Special Formulations and Considerations

• Film-forming solution (FFS) formulation of 1% terbinafine is available in some regions, which may allow for single-dose treatment of uncomplicated tinea pedis 4
• Topical terbinafine is well tolerated with minimal side effects 3
• Advantages over azole antifungals include:
  • Shorter treatment duration (1 week vs 4 weeks) 4, 2
  • Higher mycological cure rates 2
  • Fungicidal rather than fungistatic action 3

Clinical Pearls and Pitfalls

• Application technique: Apply to affected area and immediate surrounding skin
• Complete the full course: Even if symptoms improve before the week is complete
• Monitor for side effects: Though rare, periungual erythema can occur with topical application
• Avoid in pregnancy: Manufacturers caution against use in pregnancy and recommend men avoid fathering a child for 6 months after therapy 1
• Consider oral therapy: For extensive or recalcitrant infections, oral terbinafine may be more appropriate 1

Terbinafine cream's once-daily application for just one week makes it an ideal first-line therapy for superficial fungal infections, with superior efficacy and convenience compared to traditional azole antifungals that require longer treatment courses.