Comparison of efficacy of continuous terbinafine versus intermittent itraconazole in the treatment of toenail onychomycosis

Abstract

Background Oral terbinafine and oral itraconazole are two of the most common agents used for the treatment of toenail dermatophyte onychomycosis. However different studies from various parts of the world have reported conflicting results regarding efficacy of both drugs.Objective To compare efficacy of continuous terbinafine versus intermittent itraconazole in the treatment of onychomycosis. Methods This randomized Controlled Trial was conducted in the Department of Dermatology Nishtar Medical College and Hospital Multan from 20-05-2018 to 20-11-20. A total of 64 patients meeting inclusion criteria were randomly allocated in to two groups by lottery method.  Group A, having 32 patients, was treated with 250 mg terbinafine, given orally once daily for 12 weeks while group B, having 32 patients, was treated with itraconazole 400 mg per day, given orally twice a day as 200 mg per dose for 12 weeks. Patients were called for follow up every week for 16 weeks and efficacy was documented at 16 weeks of therapy.Results Of these 64 study cases, 39 (60.9 %) were male patients while 25 (39.1 %) were female patients. Mean age of our study cases was 52.67 ± 9.09 years (with minimum age of our study cases was 35 years while maximum age was 67 years). Mean age of the male patients was noted to be 54.74 ± 8.73 years while that female patients was 49.44 ± 8.85 years (p=0.022). Our study results have indicated that majority of our study cases i.e. 39 (60.9 %) were aged more than 50 years. Of these 64 study cases, 33 (51.6 %) belonged to rural areas and 31 (48.4 %) belonged to urban areas. Diabetes was present in 19 (29.7 %) of our study cases. Hypertension was present in 33 (51.6 %) of our study cases. Mean body mass index of our study cases was 26.14 ± 1.49 kg/m2 and obesity was present in 17 (26.6 %) of our study cases. Mean disease duration was 4.45 ± 2.53 years and 57 (89.1 %) had duration of illness more than 1 year. Efficacy was noted in 33 (51.6%) of our study cases, it was 23 (71.9%) in group A while efficacy was noted in 10 (31.2%) in group B patients (p = 0.002).Conclusion Our study results support the use of oral terbinafine in the treatment of toenail onychomycosis as compared with intermittent itraconazole as oral terbinafine was significantly highly efficacious. There were no adverse side effects noted in our study, so it is safe, reliable and efficacious among targeted population.