Emerging Global Patterns of Terbinafine Resistance in Trichophyton Species: A Systematic Review and Meta-Analysis

Background/Objectives: In recent years, reports regarding terbinafine resistance in Trichophyton spp. have increased. The aim of this study is to evaluate the prevalence of terbinafine resistance in Trichophyton spp. species on a regional and species basis and to systematically analyze the antifungal susceptibility testing methods used and the available data. Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA guideline. Studies published until 1 December 2025 were searched in the PubMed/MEDLINE, Scopus, Web of Science, and Embase databases. Studies reporting antifungal susceptibility test results using species-level identification, standardized, or study-defined methodologies were included. Pooled prevalence estimates were calculated with a random-effects model. Heterogeneity was evaluated with the I² statistic. Subgroup analyses were performed according to publication period, resistance definition groups, species, and geographic region. SQLE mutation patterns were summarized descriptively. Results: Nineteen studies reported from 13 different countries were included in the meta-analysis. In sensitivity analyses that included surveillance-based studies, the combined prevalence rate was found to be 3.2% (95% confidence interval 1.5-6.7). Higher descriptive resistance levels were observed in T. indotineae and T. mentagrophytes, although species-related differences were not statistically significant. Among studies reporting SQLE mutations, alterations involving codons 393 and 397 were the most frequently described; however, mutation patterns were summarized descriptively because of methodological heterogeneity among studies. Conclusions:Trichophyton spp. terbinafine resistance is an emerging global threat. Standardized susceptibility testing, harmonized epidemiological cut-off values, and enhanced molecular surveillance are essential for accurate detection, resistance monitoring, and effective clinical management.