Comparative efficacy of continuous and pulse dose terbinafine regimens in treatment of toenail onychomycosis

Abstract

Abstract

Background: The management of onychomycosis is a therapeutic challenge due to the nature and slow growth of the nail palate on the one hand and the pharmacological properties of the treatments available on the other. Pulse therapy with terbinafine has shown concussive results in terms of cure rates and the reduction of both side effects and drug interactions. The aim of this study is to evaluate the efficacy, tolerability and safety of oral terbinafine in continuous and pulse dosing schedules in the treatment of toenail dermatophytosis.

Methods:  Fifty patients of potassium hydroxide (KOH) and culture positive dermatophyte toenail onychomycosis were randomly allocated to two treatment groups receiving either continuous terbinafine 250 mg daily for 12 weeks or 3 pulses of terbinafine (each of 500mg daily for a week) repeated every 4 weeks. Patients were followed up at 4, 8 and 12 weeks during treatment and post-treatment at 24 weeks. In each patient, improvement in a target nail was assessed using a clinical score which is Onychomycosis Severity Index. Mycological, clinical cure rates, clinical effectivity and treatment failure rates were then compared.

Results: The declines in total scores from baseline were significant at each follow-up visit in both the treatment groups. However, the inter-group difference was statistically insignificant.

Conclusion: Terbinafine in pulse dosing is as effective as continuous dosing in the treatment of dermatophyte toenail onychomycosis.