A study to compare efficacy of various oral antifungals (Fluconazole, Terbinafine, Itraconazole) in treatment of Onychomycosis

Abstract

Background: Onychomycosis is accounting for upto 50% all nail disorders. It causes not only physical but also psychosocial and emotional distress to the patient. Treatment of the disease is far from satisfactory mainly due to high cost and long duration of therapy with poor patient compliance. Objective: to compare the efficacy of pulse therapy of oral Fluconazole, Terbinafine and Itraconazole. Methods: 90 patients of Onychomycosis were randomly divided into 3 treatment groups and followed up regularly. KOH smear and culture were done of all patients. Group A was given tablet Fluconazole 150 mg per week for 6 months in fingernail and 12 months in toenail onychomycosis. Group B was given tablet Terbinafine 250 mg and group C was given capsule Itraconazole 200 mg twice daily for 1st 7 days/month for 3 or 4 months in finger or toe nails involvement respectively. Results: Male Female ratio was 1:2.46 with Mostly housewives (53.33%). Distal & Lateral Subungual Onychomycosis was the most common type in 82.22% patients. Grade IV improvement was seen in 46.66% patients in group B, 40% patients in group C and 33.33% patients in group A at the end of the study. Conclusion: Both Terbinafine and Itraconazole pulse therapy is equivalent in terms of clinical cure and relapse. But Terbinafine being cost effective and having minimal drug interaction appears to be the best drug. Keywords: Onychomycosis, fluconazole, terbinafine, itraconazole