Itraconazole Pulse Research Articles

1. COMBINATION OF TRADITIONAL CO2 LASER AND PULSE DOSES ITRACONAZOLE IN PRIMARY TOTAL DYSTROPHIC ONYCHOMYCOSIS (TDO) TREATMENT: A CASE REPORT

Onychomycosis is one of the most common nail diseases. Treatment of onychomycosis, mainly moderate to severe, can be very challenging, expensive and time consuming. Compared with topical and oral therapies, laser treatment offers a more promising modality for the treatment of severe or resistant cases. To enhance the effect, the combination of oral itraconazole pulse doses with mechanical removal of the affected part of the nail plate by using ablative CO2 laser are investigated. Here, we report a total dystrophic onychomycosis case successfully treated with traditional CO 2 laser and pulse doses itraconazole. This suggests the potential of conventional ablative CO 2 laser in the treatment of severe onychomycosis.

Onychomycosis Caused by Aspergillus in a Patient with Leprosy: A Case Report

Aspergillus spp., one of the most common nondermatophyte molds (NDMs) that cause onychomycosis, are saprophytic fungi that can act as zoonotic agents and cause various health issues, including onychomycosis, in humans. Predisposing factors for onychomycosis include nail trauma, immunosuppression, and occupation. Nails in patients with leprosy are prone to change and develop onychomycosis due to unrecognized trauma to the nail area. Here, we report the case of a 25-year-old woman with 2-month history of white patches in fingernails and toenails, which were also brittle and damaged. She was a veterinarian who had frequent, direct interaction with animals, particularly dogs and cats. She denied trauma prior to the manifestation of symptoms and was undergoing leprosy treatment, including corticosteroids for leprosy reactions. Examination with potassium hydroxide revealed hyphae, and the nail culture revealed growth of fungal colonies with the characteristics of A. flavus. She received four cycles of itraconazole at 400 mg/day. Two of the three afflicted nails showed complete cure, whereas one nail showed mycologic cure. A. flavus is frequently found in animals, including dogs and cats and might have been a source of Aspergillus transmission, suggesting the patient's occupation and immunosuppression as risk factors for onychomycosis. Onychomycosis due to Aspergillus, particularly A. flavus, responds well to itraconazole pulse monotherapy.

Efficacy of topical trichloroacetic acid 100% either alone or combined with topical tioconazole 28% versus systemic itraconazole in the treatment of onychomycosis.

Treatment of onychomycosis is still challenging and warrants the development of new treatment strategies. Different trials were conducted to increase the penetration and efficacy of topical antifungals aiming at finding an alternative treatment especially when systemic antifungals are contraindicated. To evaluate the efficacy of trichloroacetic acid (TCA) 100% either alone or combined with topical tioconazole 28% versus itraconazole pulse therapy in the treatment of onychomycosis. Forty-five patients with onychomycosis were divided into three groups: group (A) treated by topical TCA 100% for 12 sessions, group (B) treated by TCA 100% for 12 sessions combined with topical tioconazole 28% for 18 weeks and group (C) treated by itraconazole (400 mg/day for 1 week/month for 4 months). TCA 100% combined with topical tioconazole 28% showed the highest therapeutic response; however, the difference between the groups was statistically insignificant. Mycological cure (negative culture) was reported in 66.7% of group B versus 60% of group A and 40% of group C at the 20 week. TCA 100% is an effective and safe treatment option for onychomycosis especially when combined with antifungals. This modality is promising in the treatment of onychomycosis especially with the increased resistance to different antifungals.

Justified use of 5 % amorolfine nail lacquer, in the treatment of toe onychomycosis

The article presents the description of three clinical cases of the successful treatment of toe onychomycosis and athlete's foot of various etiologies using 5% amorolfine antifungal nail lacquer. The first case: a 31-year-old woman was diagnosed with white superficial onychomycosis of great toe caused by T.rubrum. The treatment with 5 % amorolfine once a week for 6 months resulted in full recovery. The initiation of long-term preventive therapy with 5 % amorolfine lacquer prevented from recurrent toe onychomycosis.The second case: a 42-year-old woman developed onychomycosis after the application of decorative coating on her nails; onychomycosis was caused by Scopulariopsis brevicaulis. She was treated with itraconazole pulse therapy and 5% amorolfine lacquer. She fully recovered.
 The third case: a 65-year-old man with total onychomycosis of 10 toes developed the skin mycosis of the left foot and lower third of the leg. He was prescribed a therapy with sertaconazole cream and 5 % amorolfine lacquer. The use of 5 % amorolfine lacquer was continued to prevent from recurrent dermatomycosis.Thus, the above mentioned cases are a good example of the advantages of using 5% amorolfine lacquer in the treatment of most toe onychomycosis types caused by any pathogens (dermatophytes, yeasts or molds).

The Domestic Isolation of Terbinafine- and Itraconazole-Resistant Trichophyton indotineae in Chinese Mainland.

Trichophyton indotineae, a new species of dermatophytes, has become a significant concern in treating dermatophytosis due to the high level of terbinafine resistance reported in India and even worldwide. This study aimed to report the terbinafine- and itraconazole-resistant T. indotineae in Chinese mainland, by identifying the phylogenetic classification of the isolate strain, and detecting the drug resistance, gene mutation and expression. The skin scales of the patient were cultured on SDA and the isolate was authenticated by DNA sequencing and MALDI-TOF MS. Antifungal susceptibility testing was performed following the M38-A2 CLSI protocol to examine the MICs values of terbinafine, itraconazole, fluconazole, etc. The strain was screened for mutations in the squalene epoxidase (SQLE) gene by Sanger sequencing and detected the expression of CYP51A and CYP51B by qRT-PCR. A multi-resistant ITS genotype VIII sibling of the T. mentagrophytes complex (T. indotineae) was isolated in Chinese mainland. The strain harbored high terbinafine MIC of > 32μg/mL and itraconazole MIC of 1.0μg/mL, which was identified a mutation in the squalene epoxidase gene with amino acid substitution (Phe397Leu, mutation 1191C > A). In addition, overexpression of CYP51A and CYP51B was observed. With multiple relapses, the patient finally achieved clinical cure by itraconazole pulse therapy and topical clotrimazole cream for 5weeks. The first domestic strain of terbinafine- and itraconazole-resistant T. indotineae from a patient in Chinese mainland was isolated. Itraconazole pulse therapy can be an effective method for the treatment of T. indotineae.

Onychomycosis Involving Multiple Nails in Healthy Infants - Uncommon but Emerging Fungal Infection

Onychomycosis (OM) is common in adults but extremely rare in healthy infants. Here, we describe OM caused by Candida albicans and Trichophyton rubrum in two healthy and nonimmunocompromised infants. Multiple fingernails and toenails were involved in the form of onycholysis and yellowish discoloration in a 4-week-old neonate, whereas a 6-month-old infant presented with distal and lateral subungual type of OM. The diagnosis was established in both cases by the direct microscopic examination and fungal culture from nail scrapings. The infant with Candida OM responded to topical amorolfine with complete recovery within 3 months, while the case with T. rubrum OM was put on itraconazole pulse therapy for 3 months in the dosage of 5 mg/kg/day. We reported these cases for rarity of OM in infants, very young age of onset and multiple nail involvement in immunocompetent infants.

Q-switched Nd:YAG laser versus itraconazole pulse therapy in treatment of onychomycosis: A clinical dermoscopic and mycologic study.

Onychomycosis (OM) represents about 50% of nail disorders. Oral antifungals have proven efficacy in the treatment of onychomycosis but their associated side effects limit their use. Accordingly, there is an increased need for a safe and effective therapy to induce clearance and improve the esthetic appearance of diseased nails. The current study is an attempt to evaluate and compare the efficacy of Q-Switched Nd:YAG (1064 nm) laser as monotherapy versus pulse itraconazole in the clearance of onychomycosis. In this prospective study, 40 onychomycosis patients were equally divided into two groups: Groups I (laser group) and II (Itraconazole group). Patients of Group I are treated with six biweekly sessions of Q-Switched Nd:YAG (1064 nm) laser. Patients of Group II are treated with itraconazole pulse therapy. The assessment of clearance was rated using the "Onychomycosis Severity Index (OSI)", photographs, dermoscopy, and mycology. All 40 patients were followed up for 3months after the end of treatment. Group I's clinical improvement response was a marked improvement in 19 cases and moderate improvement in one case (OSI before treatment was 24.5 and after was 0). A dermoscopic cure occurred in 19 cases. Mycological cure was obtained in 19 cases. Group II's clinical improvement response was marked in 15 and moderate in 5 (OSI before treatment was 24 and after was 0). Dermoscopic cure occurred in 15 cases. Mycological cure was obtained in 15 cases. There were no adverse effects. The clinical response, the dermoscopic cure, and the mycological cure were equal in both groups, with no significant difference found between them. Q-Switched Nd:YAG (1064 nm) laser can be used as an effective and safe modality in the clearance of nail onychomycosis, particularly in patients who have a contraindication to or refuse the use of oral antifungals.

Comparative Study Between Pulse Therapy with Oral Itraconazole Versus Continuous Oral Terbinafine Therapy for Treatment of Onychomycosis

Objective: The purpose of this study is to evaluate the efficacy of onychomycosis treatment using pulses of oral itraconazole vs continuous dosing with oral terbinafine. Study Design: Randomized Control Trial Place and Duration of Study: Department of Dermatology, Combined Military Hospital, Abbottabad from 01 Mar, 2022 to 01 Aug, 2022. Methodology: A total of 100 patients were included in this research study who were divided in two groups through blocked randomization and were enrolled through nonprobability consecutive sampling technique. Data was collected, entered, and analyzed using SPSS Version 23.0. Results: In oral itraconazole (pulse therapy) group, 43 (86.0%) patients showed effective results while in oral terbinafine (continuous therapy) group, 32 (64.0%) showed effective results. P Value = 0.011. Conclusion: This study demonstrated that oral itraconazole (pulse therapy) is significantly superior to oral terbinafine (continuous therapy) group in the treatment of treatment of onychomycosis. Keywords: Onychomycosis, Fungal Infection, Pulsed Therapy, Continuous Itraconazole Therapy.

Fractional CO2 laser with topical 1% terbinafine cream versus oral itraconazole in the management of onychomycosis: A randomized controlled trial.

Background Onychomycosis accounts for 20-40% of all nail disorders. It is difficult to cure with resistance to anti-fungal drugs, their side effects and drug interactions limiting treatment options. Itraconazole is a widely accepted oral medication used for onychomycosis while fractional CO2 laser along with a topical anti-fungal has shown promising results for nail plate clearance in onychomycosis. Aim To compare the efficacy of fractional CO2 laser with 1% terbinafine cream versus itraconazole in the management of onychomycosis. Methods A prospective, randomised, single-centre, two-arm, parallel-group interventional study was conducted at Command Hospital Air Force, Bangalore. Onychomycosis cases confirmed by KOH mount/culture-positive were included. Patients were randomly divided into two groups. Group A received 4 sessions of fractional CO2 laser every fourth week with twice-daily application of 1% terbinafine cream; Group B received one-week pulse therapy with capsule itraconazole once every four-week for three pulses. The response was assessed by Onychomycosis Severity Index, a validated onychomycosis assessment scale, at baseline and at six months. Results Group A had 50 patients with a total of 98 nails. Clinical improvement was seen in 83/98 (84.7%) nails. The average reduction in Onychomycosis Severity Index was 8.65 (P < 0.05). Group B had 50 patients with a total of 136 nails. Clinical improvement was seen in 104/136 (76.5%) nails. The average reduction in Onychomycosis Severity Index was 7.37 (P < 0.05). Both groups showed statistically significant improvement measured by 'Reduction in Onychomycosis Severity Index' at six months; however, there was no significant difference between the two arms. Limitations The main limitations of the study are the small sample size and lack of long-term follow-up to assess recurrence of infection. Conclusion Fractional CO2 laser with 1% terbinafine cream is an effective and safe method for inducing nail clearance in onychomycosis and has efficacy similar to itraconazole pulse therapy.

Acitretin: Could it be a new therapeutic player in the field of onychomycosis?

Onychomycosis represents a therapeutic challenge. The complete cure rate with itraconazole pulse therapy remains unsatisfactory implying the need for an effective therapeutic regimen. Given the successful treatment of recurrent dermatophytosis with isotretinoin and itraconazole, we investigated the therapeutic use of acitretin in onychomycosis. To evaluate and compare the efficacy of combined itraconazole and acitretin versus monotherapy with each in onychomycosis. The study included 135 adult patients with finger- and/or toenail onychomycosis. They were equally subdivided into 3 groups: itraconazole pulse therapy, acitretin and combined itraconazole/acitretin therapy. The drugs were administered for 3months. Evaluation of severity was done by onychomycosis severity index score. Potassium hydroxide microscopy and culture were performed at baseline and at the end of the study. Mycological and complete cure of onychomycosis was observed in 51.1% and 20% of the itraconazole group, 28.9% and 28.9% of the acitretin group, and 80% and 53.3% of the combined group. There was a statistically significant difference between groups in favour of the combined itraconazole/acitretin therapy (P≤.05). Small sample and short therapy duration. Acitretin could be a powerful therapeutic player in the field of onychomycosis, with greater efficacy when combined with itraconazole.

Fractional Carbon-Dioxide Laser Plus Topical Clotrimazole versus Oral Itraconazole plus Topical Clotrimazole for Onychomycosis: A Randomized, Controlled Trial

Background: Treating onychomycosis is problematic for a variety of reasons. The very nature of the hard, protective nail plate itself makes it difficult for topical drugs to reach the fungal pathogens beneath it. Oral therapy is more effective than topical therapy, but it is expensive, requires monitoring for toxicity, and can result in multiple drug interactions. Objectives: To compare the efficacy and safety of fractional CO2 laser combined with topical clotrimazole to oral itraconazole plus topical clotrimazole in the treatment of onychomycosis. Methods: A sample of 88 adults (between the ages of 18 and 78) was randomly divided into two groups. 45 patients received fractional CO2 laser therapy at an interval of 2 weeks and twice-daily application of clotrimazole 1% cream. 43 patients were treated by pulsed itraconazole (200 mg twice daily, 1 week on, 3 weeks off) and twice-daily application of clotrimazole 1% cream. The duration of the treatment was 3 months for fingernails and 4 months for toenails in both groups. The clinical effect was measured using the Scoring Clinical Index for Onychomycosis (SCIO index), KOH examination for the affected nails were performed, and liver function tests in the two groups were analyzed. Results: 73% of patients treated with fractional ablative CO2 laser achieved a negative KOH examination compared with 79% of the itraconazole group (P&gt;0.05). The SCIO reduction in the laser group was superior to that in the itraconazole group (P&lt;0.001). Notably, a biochemical abnormality was not documented in patients who received laser treatment. In contrast, liver transaminases elevations without clinical symptoms were documented in two patients at the end of itraconazole therapy. Conclusion: Fractional CO2 laser plus a topical antifungal drug might be more clinically effective in the treatment of onychomycosis than itraconazole, without any adverse reactions. It could be an alternative for clinicians in onychomycosis cases in which oral antifungal agents are contraindicated.

Continuous terbinafine and pulse itraconazole for the treatment of non-dermatophyte mold toenail onychomycosis

Introduction Although dermatophytes are considered the predominant causative organisms in onychomycosis, non-dermatophyte mold (NDM) infections may be more prevalent than originally thought and may be more difficult to treat. There are limited data of oral antifungal efficacy in treating NDM onychomycosis. Method A retrospective chart review (2009–2016) was conducted in patients receiving continuous oral terbinafine or pulse itraconazole for toenail onychomycosis due to NDMs. Mycology results and percent nail affected were recorded with patient characteristics including demographics and concurrent diseases. Complete, clinical, and mycological cure were tabulated. Results Data from 176 patients were collected. Mycological and complete cure rates for terbinafine (69.8% and 17%) and itraconazole (67.5% and 22%) were not significantly different from each other. Regardless of oral treatment, age (p = .013), baseline severity (p = .016), and presence of atherosclerosis (p = .040) or hyperlipidemia (p = .033) decreased the likelihood of mycological cure, while age decreased the likelihood of complete cure (p = .001). Conclusion Continuous terbinafine and pulse itraconazole were similar in efficacy for curing NDM onychomycosis. Age was the most consistent prognostic factor affecting likelihood of cure, with factors that may influence drug reaching the site of infection also decreasing likelihood of mycological cure.

Combined long-pulsed Nd-Yag laser and itraconazole versus itraconazole alone in the treatment of onychomycosis nails

Background: Oral antifungal therapies are effective for onychomycosis but it was complicated by systemic effects. Effective and safe therapy is needed to improve esthetic appearance of nails.Objective: The present study is an attempt to evaluate and compare the efficacy of of combined treatment of onychomycosis with 1,064-nm long-pulsed Nd-Yag laser and pulse itraconazole therapy versus pulse itraconazole alone.Methods: Thirty onychomycosis patients were divided into two groups: Groups I and II. Patients of Group I are treated by itraconazole pulse therapy. Patients of Group II received six laser sessions with long-pulsed Nd:Yag laser and itraconazole pulse therapy. The investigators rated clearance using “Onychomycosis Severity Index (OSI)”, photographs, and mycology at 6 and 9 months after treatment.Results: Group I’s clinical improvement response was excellent in two cases, good in six cases, moderate in five cases, and mild in two cases. Mycological improvement response was excellent in two cases, good in two cases, moderate in six cases, and mild in five cases (OSI before treatment was 13.4 ± 3.02 and after was 6.67 ± 3.6). Group II’s clinical improvement response was excellent in 10, good in 3, moderate in 1, and mild in 1. Mycological improvement’s response was excellent in two cases, good in two cases, moderate in six cases, and mild in five cases (OSI before treatment was 13.33 ± 3.11 and after was 5.07 ± 4.15). There were no adverse effects. The clinical response showed best results with Group II, but the mycological cure was equal in both groups.Conclusions: The use of combined long-pulsed Nd-Yag laser and itraconazole pulse therapy gives the best clinical results and patient's satisfaction.

Antifungal Drug Use for Onychomycosis.

Onychomycoses are fungal nail infections affecting predominantly toenails, and mainly caused by dermatophyte fungi, molds and some Candida species. Nail infections can be mild with purely cosmetic implications, but they can also negatively influence quality of life. The deep-seated nature of fungi within the nail plate, prolonged treatment, poor patient adherence, frequent recurrences, and development of resistance to various antimicrobial agents make onychomycosis difficult to successfully treat. When and how should clinicians prescribe systemic and topical antifungal drugs for onychomycosis? A narrative review was undertaken of the current literature identified in Medline, Scopus, CINAHL, the Cochrane library, and Google Scholar. Treatment is often lengthy and requires persistence and patient education. Definitive mycological diagnosis, and an individualized evaluation of risks and benefits of different treatments are imperative before initiating therapy. The choice of treatment can be influenced by the age and general health of the patient, the causative organism, the number of affected nails, and the extent of nail involvement. Oral antifungals offer greater likelihood of a cure than topicals, but oral therapy carries greater risks and requires closer monitoring. Oral terbinafine is the treatment of choice, followed by itraconazole pulse regimen. The newly approved topical agents, efinaconazole and tavaborole, were superior to placebo in clinical trials and appear to produce slightly improved mycological cure rates compared to previous topicals, but further direct comparisons are needed. The treatment of onychomycosis can be challenging, as most therapeutic options are lengthy, expensive and potentially unsuccessful.

Treatment of dermatophyte toenail onychomycosis with itraconazole

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.

Randomized, 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

Background: Nondermatophyte mold (NDM) onychomycosis shows poor response to current topical, oral or device-related antifungal therapies. This study was aimed to determine the efficacy and safety of itraconazole and terbinafine pulse therapy on NDM onychomycosis. Methods: Mycologically proven subjects were treated with itraconazole 400 mg daily or terbinafine 500 mg daily for 7 days/month; two pulses for fingernails and three pulses for toenails(SLCTR/2013/013). Results: One-hundred seventy-eight patients underwent mycological studies and 148 had positive fungal isolates. NDM were the prevailing fungi, 68.2%, followed by candida species 21.6%, and dermatophytes made up only 10.1%. Out of NDM Aspergillus spp (75.1%) predominated followed by 8.9% Fusarium spp and 4.95% Penicillium spp. The clinical cure at completion of pulse therapy was statistically significant 9.2% versus 2.0% (p < 0.05) in itraconazole group. But no statistically significant difference was detected between the two regimens at the end of 12 months; 65.1% versus 54.64%. Recurrences observed in both groups (6.5% vs. 4.1%) were not statistically significant. With itraconazole pulse 68.22% Aspergillus spp, 50.0% Fusarium spp and 84.6% Penicillium spp showed clinical cure, while terbinafine pulse cured 55.0% Aspergillus spp and 50.0% Fusarium spp. Conclusions: NDM was the prevailing fungi in onychomycosis in Sri Lanka. Both itraconazole and terbinafine were partially effective on NDM onychomycosis showing a clinical cure of 54–65%. Future research should focus on searching more effective antifungal for NDM onychomycosis.

Treatment of Onychomycosis - a Clinical Study.

Introduction:Onychomycosis is a fungal infection of the nail unit. Anatomical and physiological characteristics of the nail apparatus impose the need for long-term treatment to achieve complete cure.Goal:The main goal of this project is to study the effectiveness of several treatment protocols for onychomycosis based on Scoring Clinical Index for Onychomycosis (SCIO).Material and methods:The study included 133 patients with onychomycosis, diagnosed by KOH microscopy and culture. Based on disease severity, patients were grouped into groups with SCIO values: 6-9, and 12-16. These groups were randomly subdivided to 5 subgroups according to the given treatment protocols: fluconazole 150 mg 1x weekly, itraconazole continual therapy, itraconazole pulse therapy, terbinafine 250 mg/d, and terbinafine + ciclopirox 8% lacquer, respectively. The cure rate was evaluated at the end of 48 week.Results:The obtained cure rates according to the above mentioned protocols were: 92.30%, 81.81%, 83.33%, 90.90%, and 100%, respectively for groups of patients with SCIO values 6 – 9. Within patients with SCIO values 12-16, were achieved cure rates as follows: 78.57%, 78.57%, 75%, 80%, and 86.66%.Conclusions:There was no statistically significant difference in cure rate between five treatment protocols applied in this study. In patients with high SCIO values is expected a decrease in cure rate.

趾爪白癬患者におけるランダム化二重盲検並行群間比較試験によるイトラコナゾール（ITCZ）パルス療法至適用量・サイクル試験―1年間のフォローアップを含めて―

趾爪白癬患者におけるランダム化二重盲検並行群間比較試験によるイトラコナゾール（ITCZ）パルス療法至適用量・サイクル試験―1年間のフォローアップを含めて―

Longitudinal monitoring of CYP3A activity in patients receiving 3 cycles of itraconazole pulse therapy for onychomycosis

Itraconazole, a CYP3A inhibitor, is used for the treatment for onychomycosis with a three-cycle pulse therapy over 3months, but its effects on in vivo CYP3A activity during the entire course remain unknown. Urinary 6β-hydroxycortisol/cortisol ratios were determined in 19 patients with onychomycosis, before therapy, during three cycles of itraconazole pulse therapy (200mg twice daily for a week in each monthly cycle) and at 3month after completion of therapy. The mean 6β-hydroxycortisol/cortisol ratio was reduced by 68% from baseline (P<0·05) after the 1st pulse dosing, but the inhibitory effect appeared to be resolved before the next pulse dosing and at 3months post-treatment. The magnitude of inhibition appeared in proportion to the baseline CYP3A activity. The inhibitory effect of itraconazole pulse therapy on the in vivo CYP3A activity appears clinically relevant at the end of each cycle, but the inhibition resolves, on average, within 3weeks.

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

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