The use of an intermittent terbinafine regimen for the treatment of dermatophyte toenail onychomycosis

• Published in: Journal of the European Academy of Dermatology and Venereology 2009-03, Vol.23 (3), p.256-262
• Main Authors: Gupta, AK, Lynch, LE, Kogan, N, Cooper, EA
• Format: Article
• Language: English
• Subjects: Antifungal Agents - administration & dosage; Antifungal Agents - adverse effects; Antifungal Agents - therapeutic use; Drug Administration Schedule; Humans; intermittent; Middle Aged; Naphthalenes - administration & dosage; Naphthalenes - adverse effects; Naphthalenes - therapeutic use; onychomycosis; Onychomycosis - drug therapy; pulse; terbinafine; Treatment Outcome
• ISSN: 0926-9959; 1468-3083
• DOI: 10.1111/j.1468-3083.2008.03036.x

Objective  To compare the efficacy and safety of intermittent terbinafine with standard courses of terbinafine and itraconazole for dermatophyte toenail onychomycosis. Design  Data from a Canadian study of continuous terbinafine (CTERB) and intermittent itraconazole (III) was compared to an intermittent terbinafine regimen (TOT) using similar protocol to the randomized study. Interventions  Terbinafine 250 mg/day for 4 weeks followed by 4 weeks of no terbinafine and then an additional 4 weeks of terbinafine 250 mg/day (TOT); terbinafine 250 mg/day for 12 weeks (CTERB); itraconazole pulse of 200 mg twice daily for 7 days on, 21 days off, three pulses given (III). Results  At 72 weeks, mycological cure rates (negative KOH and culture) were 36 of 43 (83.7%), 25 of 32 (78.1%), and 17 of 30 (56.7%), for the TOT, CTERB, and III groups, respectively (P = 0.01 for TOT vs. III). Effective cure rates (simultaneous mycological cure and ≤10% nail plate involvement) were 34 of 43 (79.1%), 21 of 32 (65.6%), and 11 of 30 (36.7%), respectively (P