Onychomycosis is a common fungal infection caused by dermatophytes, non-dermatophytes, and yeasts. This superficial fungal infection has been successfully managed with topical and oral antimycotics. Although current treatments with the oral antifungals, terbinafine, itraconazole, fluconazole, and the topical nail lacquers, ciclopirox and amorolfine have greatly improved treatment efficacy there are still reports of failure. In addition, some cases of onychomycosis, such as severe onychomycosis, lateral nail involvement, spike, or dermatophytoma, may require a combination of therapies for successful management. Combination therapies, compared to monotherapy with an oral or topical antifungal agent alone, may provide a broad spectrum of coverage and allow for shorter duration of therapy. Additionally, a combination of therapies may be more cost-effective. A single-blind, randomized controlled study is currently underway to evaluate the efficacy and safety of combination therapy compared to monotherapy using oral antifungals in the treatment of dermatophyte toenail onychomycosis. Patients were randomized in a 1:1:1 ratio to receive one of the following treatments: (1) itraconazole 200 mg/day administered for 4 weeks, at week 2, terbinafine 250 mg/day is commenced for the duration of 4 weeks, (2) terbinafine 250 mg/day for 12 weeks, or (3) itraconazole 200 mg twice daily for one week each month with 3 weeks off for 3 pulses. At week 48, 48.1%, 76.7%, and 63.3% of patients achieved mycological cure (negative microscopy and culture), respectively (P=0.083). Each of the regimens has been found to be safe.
Full conference title:
The 15 th Congress of the International Society for Human and Animal Mycology
- ISHAM 15th (2003)