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Treatment of Candida nail infection with terbinafine
R Segal1, A Kritzman, L Cividalli
1Department of Dermatology, Beilinson Medical Centre, Petah Tikva, Israel.
Background:
Terbinafine is a highly potent drug against dermatophytes. Data regarding its effectiveness against Candida species are few and variable.
Objective:
Our purpose was to evaluate the efficacy and safety of oral terbinafine in patients with Candida nail infection.
Methods:
In an open-label uncontrolled study, 20 patients completed 16 weeks of treatment with terbinafine, 250 mg/day, and an additional 8 weeks with placebo. Efficacy was assessed clinically and mycologically at weeks 0 (baseline), 4, 8, 16, 24, 36, and 48. Routine laboratory studies were performed at baseline and weeks 4, 8, and 16.
Results:
At the end of the trial 60% of target nails were cured clinically and mycologically; in 10% there was mycologic cure with residual clinical signs, in 25% a moderate improvement (> 50%), and failure in only 5% (one patient). Most nails were infected by Candida parapsilosis. Two of 28 patients showed mild reversible elevation of liver enzymes 1 month after initiation of terbinafine treatment.
Conclusion:
The administration of terbinafine for 16 weeks is effective in the treatment of Candida nail infection. Liver enzyme values should be determined during the first month of treatment.
Insights
Oral terbinafine effectively treats Candida nail infections, achieving significant clinical and mycological cure rates. Monitoring liver enzymes during the first month is recommended for patient safety.
Area of Science:
- Dermatology
- Mycology
- Pharmacology
Background:
- Terbinafine is a potent antifungal agent primarily effective against dermatophytes.
- Limited and inconsistent data exist on terbinafine's efficacy against Candida species.
Purpose of the Study:
- To assess the efficacy and safety of oral terbinafine for treating Candida nail infections.
Main Methods:
- An open-label, uncontrolled study involving 20 patients treated with oral terbinafine (250 mg/day) for 16 weeks, followed by 8 weeks of placebo.
- Clinical and mycological assessments were conducted at multiple time points throughout the 48-week study period.
- Routine laboratory tests, including liver enzymes, were performed at baseline and during treatment.
Main Results:
- A 60% rate of complete clinical and mycological cure was observed.
- An additional 10% achieved mycological cure with persistent clinical signs, and 25% showed moderate improvement.
- Only 5% of patients experienced treatment failure. Mild, reversible elevations in liver enzymes were noted in two patients.
Conclusions:
- A 16-week course of oral terbinafine demonstrates effectiveness in treating Candida onychomycosis (nail infection).
- Monitoring of liver enzyme levels is advised within the initial month of terbinafine therapy.