terbinafine, Lamisil
A questionnaire study on the management of onychomycosis: a Canadian perspective.

Gupta AK, Shear NH.

Department of Medicine, Sunnybrook Health Science Center, Toronto, Canada. agupta execulink.com

BACKGROUND: Onychomycosis of the toenails is a condition that responds poorly to griseofulvin. The introduction of terbinafine in Canada in May 1993 resulted in a marked shift in the choice of treatment for pedal onychomycosis. METHODS: A questionnaire survey was carried out in 1996 among Canadian dermatologists regarding the management of onychomycosis. RESULTS: There were 160 respondents from the roughly 350 practicing dermatologists. The dermatologists saw 8 +/- 0.6 patients per week (average +/- standard error (SE) with suspected or diagnosed onychomycosis, with 5 +/- 0.5 patients per week consulting the dermatologists for the first time. Most dermatologists performed mycological testing prior to starting treatment for onychomycosis. The management options for onychomycosis (mean +/- SE) were oral systemic antifungal therapy 51 +/- 3%, no therapy 31 +/- 3%, and nondrug therapy 9 +/- 2%. The majority of dermatologists (83%) used terbinafine as first-line therapy if, indeed, they used oral antifungal agents. In contrast, griseofulvin and ketoconazole were used as first-line therapy in 5% and 1% of cases, respectively. In Canada, there are no monitoring requirements when using oral terbinafine for onychomycosis. Therefore, it is not surprising that only 30% of dermatologists performed monitoring with terbinafine. In contrast, the frequency of monitoring with griseofulvin and ketoconazole was 40% and 80%, respectively. The subset of dermatologists who reported monitoring carried it out in only a fraction of their patients: 47%, 53% and 83% for terbinafine, griseofulvin, and ketoconazole, respectively. Therefore, the overall number of patients in whom regular monitoring was performed was 14.1% 21.2%, and 71.4% for terbinafine, griseofulvin, and ketoconazole, respectively. The perceived cure rates with terbinafine and griseofulvin (mean +/- SE) were 83.7 +/- 1% and 41 +/- 3.1%, respectively. CONCLUSIONS: In May 1996, within three years of the introduction of terbinafine to Canada, this agent has become the drug of choice for the treatment of pedal onychomycosis (at the time of the survey neither itraconazole or fluconazole were approved for onychomycosis). Terbinafine has been found to be very effective and safe, and only a minority of dermatologists perform regular monitoring with this drug.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9646138&dopt=Abstract terbinafine Lamisil



terbinafine, Lamisil
Enhanced activity of antifungal drugs by lysozyme against Cryptococcus neoformans.

Nakamura Y, Kano R, Watanabe S, Takahashi H, Hasegawa A.

Teikyo University School of Medicine, Department of Dermatology, Tokyo, Japan.

The in vitro susceptibility of 16 isolates of Cryptococcus neoformans to three antifungal drugs and lysozyme in combination was determined using an urea broth microdilution method. The antifungal activities of each drug alone against 16 isolates of Cr. neoformans were determined as mean minimal inhibitory concentrations (MICs). MICs of fluconazole, itraconazole and terbinafine were 2.0 micrograms ml-1, 0.004 microgram ml-1 and 0.25 microgram ml-1, respectively. Lysozyme alone inhibited the growth of Cr. neoformans in a dose-dependent manner, although the lysozyme was unable to kill the cells of Cr. neoformans at the highest concentration of 20 micrograms ml-1. The mean MICs of fluconazole, itraconazole and terbinafine in combination with lysozyme were 0.13 microgram ml-1, 0.004 microgram ml-1 and 0.03 microgram ml-1 respectively. The antifungal activity of fluconazole and terbinafine in combination with lysozyme against Cr. neoformans was greatly enhanced compared with that of each drug alone. Itraconazole was unable to enhance the antifungal activity, as it demonstrated higher activity against Cr. neoformans when alone rather than in combination. Lysozyme was confirmed to enhance the antifungal activity of fluconazole and terbinafine in vitro.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9715633&dopt=Abstract terbinafine Lamisil



terbinafine, Lamisil
Relapses of onychomycosis after successful treatment with systemic antifungals: a three-year follow-up.

Tosti A, Piraccini BM, Stinchi C, Colombo MD.

Department of Dermatology, University of Bologna, Italy.

BACKGROUND: Data about relapses of onychomycosis after treatment with the new systemic antifungals vary among the different studies, with figures ranging from 3 to 20% for terbinafine and from 21 to 27% for itraconazole, depending on the follow-up duration. OBJECTIVE: To determine the prevalence of relapses of onychomycosis cured by terbinafine compared with that of onychomycosis cured by itraconazole. METHODS: We followed up 47 patients whose toenail onychomycosis had been mycologically cured in an open randomized study comparing intermittent itraconazole treatment with continuous terbinafine treatment and intermittent terbinafine therapy. Patients were examined every 3 months for up to 3 years after the end of therapy. At each visit clinical and mycologic (direct microscopy and cultures) evaluations were performed. RESULTS: Eight of the 36 patients (22.2%) who completed the study had a relapse of onychomycosis during the follow-up period, including 2 patients of the terbinafine 250 mg group, 2 patients of the terbinafine 500 mg group and 4 patients in the itraconazole 400 mg group. As the original infection, the relapse was caused in all cases by Trichophyton rubrum. CONCLUSIONS: This study shows that 22.2% of patients with onychomycosis successfully treated with systemic antifungals experienced a relapse. The relapse rate increased from 8. 3% at month 12 to 19.4% at month 24 and to 22.2% at month 36. Relapses were more common in patients treated with pulse itraconazole (4/11) than in patients treated with continuous (2/12) or intermittent (2/13) terbinafine. Statistical analysis did not reveal any significant difference between relapse rates in the three groups.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9732167&dopt=Abstract terbinafine Lamisil



terbinafine, Lamisil
In vitro activity of terbinafine against clinical isolates of dermatophytes.

Arzeni D, Barchiesi F, Compagnucci P, Cellini A, Simonetti O, Offidani AM, Scalise G.

Istituto di Malattie Infettive e Medicina Pubblica, Universita degli Studi di Ancona, Italy.

A broth macrodilution method following the recommendations established by the National Committee for Clinical Laboratory Standards was employed for testing terbinafine against 20 clinical isolates of dermatophytes belonging to seven species. The minimal inhibitory concentrations resulting in either 80% or 100% inhibition of growth, compared to growth in drug-free control tubes, ranged from </=0.03 to 0.25 g ml-1 and from </=0.03 to 2.0 g ml-1, respectively. Terbinafine was shown to be fungicidal at a concentration of </=1.0 microg ml-1 for 19 isolates. No differences in susceptibilities were found between strains isolated from HIV-positive and -negative individuals.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9776840&dopt=Abstract terbinafine Lamisil



terbinafine, Lamisil
In vitro evaluation of terbinafine and itraconazole against dematiaceous fungi.

McGinnis MR, Pasarell L.

University of Texas Medical Branch, Department of Pathology and WHO Collaborating Center for Tropical Diseases, 301 University Boulevard, Galveston 77555-0609, TX, USA.mmcginni utmb.edu

Two hundred and three isolates representing 15 species of filamentous ascomycetes were evaluated against terbinafine and itraconazole using a modification of the NCCLS M27-A standard reference method for yeasts. The MIC ranges and geometric means were similar, although terbinafine tended to have the lowest values. The loculoIascomycete clade tested had consistently low MIC geometric mean values for its members, ranging from 0.03 to 0.17 microg ml-1 for terbinafine and 0.03-0.37 microg ml-1 for itraconazole.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9776842&dopt=Abstract terbinafine Lamisil



terbinafine, Lamisil
[Limits of brief treatment of onychomycoses]

[Article in German]

Seebacher C.

Hautklinik, Krankenhauses Dresden-Friedrichstadt-Stadtisches Klinikum.

New antifungals for oral therapy have improved the chances of healing onychomycoses. Nevertheless, in daily practice the failure rate is 20-30% both with itraconazole and terbinafine. In our investigations for the fungicidal effects of terbinafine, we could show that the same strain of Trichophyton rubrum or T. mentagrophytes in the rest period needs 1000 times higher concentration of terbinafine (2.0 to 0.002 microgram/ml) for complete fungal killing as in the growth phase. Thus resting fungi in the nail are not harmed, and if the concentration of terbinafine is lower than the MIC for the fungi, they can cause a relapse. Itraconazole is a fungistatic agent. Its concentration in the nail plate must be higher than the MIC for the causative fungi for a long time-10 to 12 months. The usual short-term treatment of onychomycosis over 3 months can be insufficient in individual cases such as patients with disorders, e.g. circulatory disorders or slowed nail growth.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9794158&dopt=Abstract terbinafine Lamisil



terbinafine, Lamisil
Tinea capitis dermatophytes: susceptibility to antifungal drugs tested in vitro and in vivo.

Mock M, Monod M, Baudraz-Rosselet F, Panizzon RG.

Mycology Laboratory, Departement Hospitalier Universitaire Romand de Dermatologie et Venereologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

BACKGROUND: Tinea capitis is a worldwide-spread infection of the scalp caused by dermatophytes and is predominantly seen in children. The clinical manifestations range from mild scaling lesions to widespread alopecia or highly inflammatory suppurating lesions. Terbinafine and itraconazole seem to be promising therapies with shorter treatment durations than griseofulvin. OBJECTIVE: The objective of the present study was to test the sensitivity of different species of dermatophytes towards terbinafine and itraconazole, and to compare the results with a retrospective study on 35 immunocompetent patients with tinea capitis who were treated with terbinafine (Lamisil(R)). METHODS: Minimal inhibitory concentrations (MIC) were measured with an agar dilution method. RESULTS: Each tested species of dermatophyte was sensitive to terbinafine and itraconazole at different concentration ranges. The MIC for terbinafine ranged from 0.005 to 0.5 microg/ml and for itraconazole from 40 to 80 microg/ml. Microsporum canis was the dermatophyte least sensitive to terbinafine. Our retrospective study showed that the cure rate was excellent for Trichophyton violaceum and T. soudanense, variable for T. mentagrophytes and poor for M. canis and M. langeronii. CONCLUSIONS: (i) Regarding the results of susceptibility tests obtained with species involved in tinea capitis, clinical efficacy is not related to MIC measured in vitro; (ii) identification of the isolated dermatophyte from tinea capitis seems to be important for choosing the appropriate treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9873175&dopt=Abstract terbinafine Lamisil