What are the oral treatment options for Tinea infections?

Oral Treatment Options for Tinea Infections

For tinea infections requiring systemic therapy, oral terbinafine is the first-line treatment due to its superior efficacy compared to griseofulvin, with specific dosing regimens based on the type of tinea infection. 1, 2

First-Line Oral Treatment Options

• Terbinafine is the preferred oral agent for most dermatophyte infections, showing greater efficacy than griseofulvin for tinea corporis, tinea cruris, and tinea pedis 2
• For tinea capitis, oral therapy is required as topical therapy alone is ineffective 1
  • First-line: Griseofulvin 20mg/kg daily for 6-8 weeks (for children) 1
  • Alternative: Terbinafine is more effective for Trichophyton species infections (250mg daily for adults) 1, 2

Specific Dosing Regimens by Type of Tinea

• Tinea corporis/cruris:

  • Terbinafine 250mg once daily for 1-2 weeks 3, 4
  • Alternative: Griseofulvin 500mg daily for 2-4 weeks (less effective with higher relapse rates) 4, 5

• Tinea pedis:

  • Terbinafine 250mg daily for 1-2 weeks (especially effective for moccasin-type) 6
  • Alternative: Griseofulvin 0.5-1.0g daily for 4-8 weeks 5

• Tinea unguium (onychomycosis):

  • Terbinafine 250mg daily for at least 6 weeks (fingernails) or 12 weeks (toenails) 2
  • Alternative: Griseofulvin 0.5-1.0g daily for at least 4 months (fingernails) or 6 months (toenails) 5

Important Clinical Considerations

• Accurate diagnosis is essential before initiating treatment - ideally confirmed through microscopy using potassium hydroxide preparation or culture 1, 5
• Treatment should continue until the infecting organism is completely eradicated as indicated by appropriate clinical or laboratory examination 5
• Mycological cure rates with terbinafine generally improve after treatment cessation due to its fungicidal mechanism and residual effect in tissue 2
• For extensive disease or cases resistant to topical therapy, itraconazole 50-100mg daily for 2-4 weeks can be considered as an alternative 7

Treatment Monitoring and Prevention of Recurrence

• Follow-up should include both clinical and mycological assessment until clearance is documented 7, 1
• General hygiene measures should be observed to control sources of infection or reinfection 5
• Cleaning contaminated personal items with disinfectant is recommended to prevent recurrence 1
• For anthropophilic infections, screening and treating family members can help prevent recurrence 1

Cautions and Contraindications

• Griseofulvin is not effective for tinea versicolor, bacterial infections, candidiasis, or other non-dermatophyte fungal infections 5
• Terbinafine has a relatively low potential for drug interactions compared to azole antifungals 2
• Treatment should continue for at least one week after clinical clearing of infection to prevent relapse 8