The successful treatment of Trichophyton rubrum nail bed (distal subungual) onychomycosis with intermittent pulse-dosed terbinafine
| Autor: | Gerbert Rebell, Nardo Zaias |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
medicine.medical_specialty
Antifungal Agents Distal subungual onychomycosis Administration Oral Pilot Projects Dermatology Naphthalenes medicine.disease_cause Severity of Illness Index Trichophyton Onychomycosis Medicine Humans Prospective Studies Terbinafine Mycosis Foot Dermatoses business.industry Standard treatment General Medicine Nail plate medicine.disease Surgery medicine.anatomical_structure Treatment Outcome Nail disease Pulse Therapy Drug Dermatophyte Nail (anatomy) business medicine.drug |
| Zdroj: | Archives of dermatology. 140(6) |
| ISSN: | 0003-987X |
| Popis: | Background: The standard treatment of Trichophyton rubrumnailbedonychomycosis(ordistalsubungualonychomycosis [DSO]) with daily terbinafine for 12 weeks involves treating for a fixed period shorter than the time required for complete replacement of the nail bed and overlying nail plate by normal growth. The same total amount of terbinafine pulse-dosed for approximately 12 months would treat the patient until normal replacement of the mycotic nail bed has occurred. Objectives:To determine the effectiveness of intermittent administration of oral terbinafine (250 mg/d for 7 consecutive days every 2-4 months) to cure DSO and to determine the maximum effective treatment interval. Design: A prospective, nonrandomized, open study of sequential groups of office patients. Setting: A private dermatology practice. Methods:Asequenceof4groupsofofficepatientswith DSO (n=10-20 each) were treated with pulse-dosed terbinafine for 7 consecutive days at intervals of 2, 3, and 4 months, respectively. In each group, treatment was continued until the distally advancing new nail bed and nail had completely removed the mycotic defect or failure of fungistasis was detected. Main Outcome Measurement: Results were determined by monthly evaluation. Cure was noted as complete replacement of the mycotic nail bed and overlying nail plate (ascertained by monthly metric measurementsofthemycosis-freenailbedandoverlyingnailplace distal to the proximal nail fold). Treatment failure was notedwhenthemycosis-freeproximalportionofthenail bed failed to increase in correspondence with the distallydirectedmovementofthenailbedandoverlyingnail. Results: Thirty-nine (93%) of the 42 patients in the first 3 groups were cured (95% binomial confidence interval, 67%-100%)withnoevidenceofdecreaseinefficacy.However, the group of patients who received the 7-day pulse treatment every 4 months experienced significantly more failures (P.01), and cures dropped to 10 of 17 cases. Conclusion:TerbinafineisaneffectivetreatmentforDSO when pulse-dosed for 7 days every 3 months but not every 4 months. Arch Dermatol. 2004;140:691-695 |
| Databáze: | OpenAIRE |
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