From the FDA Drug Label
DOSAGE AND ADMINISTRATION Sufficient Econazole Nitrate Cream, 1% should be applied to cover affected areas once daily in patients with tinea pedis, tinea cruris, tinea corporis, and tinea versicolor, and twice daily (morning and evening) in patients with cutaneous candidiasis INDICATIONS AND USAGE Econazole Nitrate Cream is indicated for topical application in the treatment of tinea pedis, tinea cruris, and tinea corporis caused by Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton tonsurans, Microsporum canis, Microsporum audouini, Microsporum gypseum, and Epidermophyton floccosum, in the treatment of cutaneous candidiasis, and in the treatment of tinea versicolor.
The treatment of tinea pedis in a male with chronic hepatitis B using econazole is to apply the cream once daily for one month to reduce the possibility of recurrence 1. Econazole is indicated for the treatment of tinea pedis caused by various fungi 1.
- The presence of chronic hepatitis B is not mentioned in the drug label as a consideration for treatment with econazole.
- Therefore, the treatment should be approached with caution and the patient should be monitored for any potential interactions or adverse effects.
From the Research
For treating tinea pedis (athlete's foot) in a male with chronic hepatitis B, I recommend a topical antifungal medication as first-line therapy, specifically terbinafine 1% cream applied twice daily for 1-2 weeks, as it has been shown to be highly effective and safe in recent studies, including a 2023 review 2. The affected area should be kept clean and dry, with medication applied to clean, dry feet, extending slightly beyond the affected areas. For severe or resistant cases, oral terbinafine 250 mg daily for 2 weeks may be necessary, but requires careful monitoring of liver function tests due to the patient's chronic hepatitis B, as oral antifungals can potentially cause hepatotoxicity, which is particularly concerning in patients with pre-existing liver disease 3. Prevention measures include wearing breathable footwear, changing socks daily, using antifungal powder in shoes, and avoiding walking barefoot in public areas. Treatment success depends on completing the full course of medication even after symptoms improve, as premature discontinuation often leads to recurrence. If the infection doesn't respond to initial treatment or frequently recurs, consider evaluation for possible secondary bacterial infection or other dermatological conditions. A meta-analysis of various topical formulations of terbinafine has shown that it is very well tolerated and has high efficacy as a cure for tinea pedis, irrespective of type of pharmaceutical formulation, treatment duration, and frequency of application 4. Additionally, a comparison of terbinafine and clotrimazole in treating tinea pedis has shown that terbinafine is more effective in terms of mycological cure and effective treatment 5. It is essential to note that the patient's chronic hepatitis B should be taken into consideration when choosing the treatment, and liver function tests should be monitored closely if oral antifungals are prescribed.