Treatment of dermatophyte toenail onychomycosis with itraconazole
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20164754Keywords:
Itraconazole, Onychomycosis, Pulse therapyAbstract
Background: Onychomycosis is fungal infection of nail. The prevalence of onychomycosis varies across the world. It is lower in tropical countries (3.8%) than in sub-tropical countries and countries in the temperate zone (23%). The risk of onychomycosis is higher in persons with diabetes mellitus and human immunodeficiency virus infection. Systemic antifungals are recommended for treatment. Topical antifungals are less effective. Different cure rates have been reported by different authors for terbinafine, itraconazole and fluconazole therapy. A variety of regimens (continuous or pulse) have also been suggested.
Methods: Here in this study we report a prospective, observational, cohort study of pulse itraconazole therapy in toenail onychomycosis caused by dermatophytes over a period of one year in patients with SCIO scores between 6 to 9.
Results: It was observed that mean age of patients was 38.96 years. 57.27 % study subjects had complete clinical improvement to oral itraconazole three pulses regimen. One pulse consisted of 200 mg twice per day given for one week, followed by a three weeks interval. Thus, this regimen was repeated thrice.
Conclusions: This study shows the substantial benefit with itraconazole pulse regimen in toenail onychomycosis. The outcome this study is comparable with previously published data and may encourage the usage of itraconazole pulse regimen for the treatment of dermatophyte toenail onychomycosis in adults.
References
Westerberg DP, Yoyack MJ. Onchomycosis: current trends in the diagnosis and management. Am Fam Physician. 2013;88:762-70.
Ranawaka RR, Nagahawatte, Gunasekara TA. Randomised, double-blind, comparative study on efficacy and safety of itraconazole pulse therapy and terbinafine pulse therapy on nondermatophyte mold onychomycosis: a study with 90 patients. J Dermatol Treat. 2016;27:364-72.
James Q, Del R. The role of topical antifungal therapy for onvhomycosis and emergence of new agents. J Clin Aesthet Dermatol. 2014;7(7):10-8.
Bennett JE. Antifungal agents. In: Brunton LL, Chabner BA, Knollmann BC. eds. Goodman and Gillman’s The Pharmacological Basis of Therapeutics. 12th ed. New York, NY: McGraw-Hill; 2011:1571-1592.
Nenoff P, Paash U, Handrick W. Infectionn of finger and toenails due to fungi and bacteria. Hautarzt. 2014;65:337-46.
Takahata Y, Hiruma Y, Shiraki Y. Treatment of dermatpphyte onychomycosis with three pulses of terbinafine (500 mg per day for a week). Mycosis 2008;52:72-6.
Sergeev AY, Gupta AK, Sergeev VV. The scoring clinical index for onchomycosis. Skin Therapy Let. 2002;7:6-7.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruis I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239-45.
Hartwig SC, Siegel J, Schneider PJ. Preventability and severity assessment in reporting adverse drug reactions. Am J Hosp Pharm. 1992;49:2229-32.
Schumock GT, Thornton JP. Focusing on the preventability of adverse drug reactions. Hosp Pharm. 1992;27:538.
Ahmad A, Ali E, Khondker L, Ishamkhan MS. Pulse dose of oral itraconazole is effective in the treatment of onchomycosis. J Pak Asso Dermatol. 2011;21:276-80.
Mishra M, Panda P, Tripathy S. An open randomized comparative study of oral itraconazole pulse and terbinafine pulse in the treatment of onychomycosis. Indian J Dermatol Venerol Leprol. 2005;71:262-6.
Gupta AK, Paquet M, Simpson FC. Therapies for the treatment of onchomycosis. Clin Dermatol. 2013;31:544-54.
Gupta AK, Grover MD, Lynde CW. Pulse itraconazole versus continuous terbinafine for treatment of dermatophyte toenail onchomycosis in patients with diabetes mellitus. J Eur Acad Dermatol Venereol. 2006;20:1168-93.
Vora DN, Solanki P, Kothari A, Meher K. Study to compare efficacy of various antifungals (fluconazole, terbinafine, itraconazole) in the treatment of onychomycosis. J Res Med Den SCI. 2014;2:49-51.
Coehlo de sa D, Lamas APB, Tosti A. Drug therapy for onychomycosis: an evidence based review. Am J Clin Dermatol. 2014;15:17-36.
Pajaziti L, Vasiti E. Treatment of onychomycosis - A clinical study. Med Arh. 2015;69:173-6.
