A comparative study of efficacy of Itraconazole versus Terbinafine and their cost effectiveness in the treatment of resistant dermatophytosis of skin at Nalanda Medical College, A tertiary care teaching hospital of Patna.

Dr. Shubhra Bishwas; Dr. (Prof.) Sanjay Kumar

Volume : IX, Issue : III, March - 2020

A comparative study of efficacy of Itraconazole versus Terbinafine and their cost effectiveness in the treatment of resistant dermatophytosis of skin at Nalanda Medical College, A tertiary care teaching hospital of Patna.

Dr. Shubhra Bishwas, Dr. Prof. Sanjay Kumar

Abstract :

Background- Dermatophytoses are common fungal infections prevalent in hot and humid climate. Itraconazole and Terbinafine are commonly used antifungal agents for the treatment of dermatophytoses. However, increased resistance is being seen with conventional doses of these drugs. Also, these infections are more common among low socio-economic population. Therefore, this study has been undertaken to compare the efficacy and cost effectiveness of Itraconazole and Terbinafine in increased dosages in resistant dermatophytoses of skin. Objectives- To compare the efficacy of Itraconazole and Terbinafine in increased dosages in resistant dermatophytoses of skin and to select cheaper drug among them. Materials and Methods- In this open, parallel, prospective, comparative study, 200 patients of Tinea cruris and Tinea corporis diagnosed clinically and confirmed by potassium hydroxide (KOH) test, were randomly and equally divided into two groups. Group I patients received Itraconazole 200mg twice daily while group II patients received Terbinafine 250mg twice daily for 4 weeks. Patients were evaluated at the end of 2 and 4 weeks.At the end of 4 weeks KOH test was repeated to evaluate mycological cure. Results- At the end of 4 weeks mycological and clinical cure was seen in 92% patients in group I while 75% patients in group II. Mild adverse effects like headache, taste disturbances and gastrointestinal upset were observed in few patients of both groups but none was significant enough to discontinue therapy. Cost of therapy was more with Itraconazole than that of Terbinafine. Conclusion- High dose Itraconazole therapy is more effective than high dose Terbinafine therapy in resistant dermatophytoses. However cost of therapy is more in case of Itraconazole. But Terbinafine has higher failure rates and the duration of treatment may require longer, thereby reducing the cost difference. Therefore, Itraconazole seems superior to Terbinafine in the treatment of resistant T.corporis and T. cruris infection in higher doses.