Combination therapy consisting of week pulses of oral terbinafine plus topical application of terbinafine cream in the treatment of onychomycosis

Abstract

BACKGROUND: Terbinafine, based on its pharmacokinetic properties, is a good candidate for pulse therapy. There are, as yet, no current guidelines for a terbinafine 1‐week pulse regimine.

OBJECTIVE: To determine the optimal 1‐week pulse dosing regimen for combination therapy of oral terbinafine with complementary 1% terbinafine cream for the treatment of onychomycosis.

DESIGN: A total of 69 onychomycosis patients received 250 mg terbinafine, given orally once daily for 7 days as 1‐week pulses, separated by intervals of 2–3 weeks, until the desired improvement was observed. A daily application of 1% terbinafine cream was advised through to the evaluation date at 12 months follow‐up. The treatment regimens were compared based on the number of pulses and the duration of treatment.

RESULTS: The 45 patients (65.2%) who achieved complete cure received an average of 7.8±3.5 pulse treatments over 4.8±2.6 months. The optimal terbinafine dosing regimen consisted of alternate 1‐week pulses, with most patients on this regimen (19/20 cases; 95%) achieving total cure.

CONCLUSION: Favorable treatment outcome was gained from this terbinafine 1‐week pulse regimen and also better compliance compared with a standard daily regimen.

• Minimal dose
• Onychomycosis
• Oral treatment
• Week pulse terbinafine