Oral treatments for fungal infections of the skin of the foot.
Abstract
Background
About 15% of the population have fungal infections of the feet (tinea pedis or athlete's foot). Whilst there are many clinical presentations of tinea pedis the most common are between the toes (interdigital) and on the soles, heels and sides of the foot (plantar) which is known as moccasin foot. Once acquired the infection can spread to other sites including the nails, which can be a source of reinfection. Oral therapy is usually used for chronic conditions or when topical treatment has failed.
Objectives
To assess the effects and costs of oral treatments for fungal infections of the skin of the foot (tinea pedis).
Search methods
Randomised controlled trials were identified from MEDLINE, EMBASE and CINAHL from the beginning of these databases to January 2000. We also searched the Cochrane Controlled trials Register (Cochrane Library issue 1, 2000) the Science Citation Index, BIOSIS, CAB‐Health, Health star and Economic databases. Bibliographies were searched, podiatry journals hand searched and the pharmaceutical industry and schools of podiatry contacted.
Selection criteria
Randomised controlled trials including participants who have a clinically diagnosed tinea pedis, confirmed by microscopy and growth of dermatophytes in culture.
Data collection and analysis
Study selection was done by two independent reviewers. Methodological quality assessment and data collection was also assessed by two independent reviewers.
Main results
Twelve trials, involving 700 participants, were included. The two trials comparing terbinafine and griseofulvin produced a pooled risk difference of 52% (95% CI 33% to 71%) in favour of terbinafine's ability to cure infection. No significant difference was detected between terbinafine and itraconazole; fluconazole and either itraconazole and ketoconazole; or between griseofulvin and ketoconazole, although the trials were generally small. Two trials showed that terbinafine and itraconazole were effective compared with placebo. Adverse effects were reported for all drugs, with gastrointestinal effects most commonly reported.
Authors' conclusions
The evidence suggests that terbinafine is more effective than griseofulvin and that terbinafine and itraconazole are more effective than no treatment.
PICOs
Plain language summary
Oral antifungal drugs for treating athlete's foot (tinea pedis).
Athlete's foot (tinea pedis) is a fungal infection of the feet that is easily spread and difficult to get rid of. This review compared different oral antifungal drugs and found that terbinafine and itraconazole were both more effective than placebo. Terbinafine works faster and is more effective than griseofulvin, but costs more. Trials of other drugs were not large enough to show differences between them. All drugs had side effects, gastrointestinal effects were the most common. More research is needed to determine the cost effectiveness of different treatment approaches.
