From the Guidelines
For extensive athlete's foot, oral terbinafine is the most effective treatment option, with a recommended dose of 250 mg once daily for 1 week, offering similar efficacy to 4 weeks of clotrimazole 1% cream applied twice a day but with faster clinical resolution. When considering treatment options, it's essential to prioritize morbidity, mortality, and quality of life as the outcome. According to the study published in Pediatrics in 2017 1, oral terbinafine has similar efficacy to clotrimazole 1% cream but with faster clinical resolution.
Some key points to consider when treating extensive athlete's foot include:
- Oral terbinafine, 250 mg, given once daily for 1 week, has similar efficacy to 4 weeks of clotrimazole 1% cream applied twice a day but with faster clinical resolution 1
- Terbinafine is well tolerated in children, with the most concerning potential adverse events being occasional isolated neutropenia and rare liver failure, typically in people with preexisting liver disease 1
- To prevent reinfection, keep the affected areas clean and dry, wear breathable footwear, change socks daily, and avoid walking barefoot in public areas
- For very extensive or resistant infections, you might need to supplement with oral antifungal medication prescribed by a healthcare provider
It's crucial to note that while clotrimazole 1% cream is an effective treatment option, oral terbinafine offers faster clinical resolution and similar efficacy, making it the preferred choice for extensive athlete's foot. As always, consult a healthcare provider before starting any treatment, especially if you have preexisting liver disease or are concerned about potential adverse events.
From the FDA Drug Label
Uses • cures most athlete's foot (tinea pedis) PRINCIPAL DISPLAY PANEL - 30 g Carton Cures Most Athlete's Foot Terbinafine Hydrochloride Cream 1% Antifungal Cream Full Prescription Strength NET WT 1 oz (30 g) The best cream for extensive athlete's foot is Terbinafine cream, as it cures most athlete's foot 2 and is available in full prescription strength 2.
- Key benefits: cures most athlete's foot, relieves itching, burning, cracking, and scaling.
- Important note: For athlete's foot, it is essential to follow proper hygiene and footwear practices, as mentioned in the miconazole label 3.
From the Research
Treatment Options for Athlete's Foot
- Topical antifungal therapy is the mainstay of treatment for superficial or localized tinea pedis, with examples of topical antifungal agents including allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate, and amorolfine 4
- Oral antifungal therapy should be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis, or in immunocompromised patients, with oral antifungal agents including terbinafine, itraconazole, and fluconazole 4
Efficacy of Terbinafine
- Terbinafine has been shown to be effective in treating tinea pedis, with a cure rate of 78% achieved in patients with tinea pedis after a single application of 1% terbinafine cream 5
- Terbinafine 1% cream applied twice daily for 1 week was significantly superior to a 4-week course of clotrimazole 1% cream for treating tinea pedis 5
- The evidence suggests that terbinafine is more effective than griseofulvin, and that terbinafine and itraconazole are more effective than no treatment 6, 7
Comparison of Treatments
- A randomized, double-blind trial of topical treatment with terbinafine 1% cream versus its vehicle (placebo) showed that terbinafine was significantly more effective than placebo at the end of therapy (78% vs zero) and at the 2-week follow-up (89% vs zero) (p less than or equal to 0.001 at both intervals) 8
- No significant difference was detected between terbinafine and itraconazole, fluconazole and itraconazole, fluconazole and ketoconazole, or between griseofulvin and ketoconazole, although the trials were generally small 6, 7