Academic literature on the topic 'Ciclopirox Olamine; Terbinafine Hydrochloride'

Background: Dermatophytosis management is difficult in Bangladesh, and there have been reports of systemic antifungals being used at greater doses. However, there have been numerous reports of increased treatment failures with terbinafine at standard dosage, consequently we performed this study to compare the efficacy and safety of terbinafine at high dose with terbinafine fluconazole at 150mg weekly dose. In both arms, topical ciclopirox olamine was used. Objectives: The aim of the study was to compare of the efficacy of terbinafine versus and co-administration of terbinafine and fluconazole in patients of tinea corporis. Methods: This was randomized, open label, comparative study where 80 patients with tinea corporis et cruris infection were included. Patients were either prescribed terbinafine 250mg twice a day or Terbinafine 250mg daily and Fluconazole 150mg weekly. Efficacy was assessed based on complete, clinical and mycological cure rate. Safety was assessed by evaluating adverse events and monitoring liver function of patients. Results: Total 80 patients completed the study with 40 in each group. 81.5% patients achieved complete cure in Terbinafine and Fluconazole group compared to 73.9% patients in Terbinafine group. At the end of 6 weeks, there was a statistically significant improvement (p value<0.05) in the total symptom score (erythema, scaling, and pruritus) in Terbinafine as well as in terbinafine and fluconazole compared to baseline. None of the patients showed any significant side effect in both groups. No changes in liver function were observed in both the groups. Conclusion: This study shows that the high dose of terbinafine and Co-administration of standard dose of terbinafine fluconazole along with CPO is effective and safe in management of tinea corporis et cruris.

Chronic recalcitrant dermatophytoses, due to Trichophyton (T.) mentagrophytes Type VIII are on the rise in India and are noteworthy for their predominance. It would not be wrong to assume that travel and migration would be responsible for the spread of T. mentagrophytes Type VIII from India, with many strains resistant to terbinafine, to other parts of the world. From September 2016 until March 2020, a total of 29 strains of T. mentagrophytes Type VIII (India) were isolated. All patients were residents of Germany: 12 females, 15 males and the gender of the remaining two was not assignable. Patients originated from India (11), Pakistan (two), Bangladesh (one), Iraq (two), Bahrain (one), Libya (one) and other unspecified countries (10). At least two patients were German-born residents. Most samples (21) were collected in 2019 and 2020. All 29 T. mentagrophytes isolates were sequenced (internal transcribed spacer (ITS) and translation elongation factor 1-α gene (TEF1-α)). All were identified as genotype VIII (India) of T. mentagrophytes. In vitro resistance testing revealed 13/29 strains (45%) to be terbinafine-resistant with minimum inhibitory concentration (MIC) breakpoints ≥0.2 µg/mL. The remaining 16 strains (55%) were terbinafine-sensitive. Point mutation analysis revealed that 10/13 resistant strains exhibited Phe397Leu amino acid substitution of squalene epoxidase (SQLE), indicative for in vitro resistance to terbinafine. Two resistant strains showed combined Phe397Leu and Ala448Thr amino acid substitutions, and one strain a single Leu393Phe amino acid substitution. Out of 16 terbinafine-sensitive strains, in eight Ala448Thr, and in one Ala448Thr +, new Val444 Ile amino acid substitutions were detected. Resistance to both itraconazole and voriconazole was observed in three out of 13 analyzed strains. Treatment included topical ciclopirox olamine plus topical miconazole or sertaconazole. Oral itraconazole 200 mg twice daily for four to eight weeks was found to be adequate. Terbinafine-resistant T. mentagrophytes Type VIII are being increasingly isolated. In Germany, transmission of T. mentagrophytes Type VIII from the Indian subcontinent to Europe should be viewed as a significant public health issue.

Background. Pityriasis versicolor (PV) is a ubiquitous superficial skin mycosis that often affects young adults. It is often effectively treated with local or oral antifungal agents. Cases of PV resistance to antifungal agents have been reported rarely. We report a case of antifungal resistant PV. Observation. A 22-year-old patient was followed since the age of 17 years in a dermatology outpatient clinic for hyperpigmented scaly macular lesions of the trunk and upper limbs. The clinical diagnosis of PV was retained. The patient was treated by fluconazole 300 mg/week before being lost to follow-up. He was seen again in 2019 (about 2 years later) for the same symptomatology and treated again by fluconazole and ciclopirox olamine cream without improvement. He was again lost to follow-up and seen again six months later. A mycological sample was taken and Aspergillus niger was isolated. The patient was treated by itraconazole for 6 weeks. The evolution was marked by a clinical status quo. The patient was again put on salicylated petroleum jelly 10% associated with terbinafine cream and then lost to follow-up. Conclusion. The emergence of fungal resistance to antifungal drugs does not spare PV. It can therefore be resistant to several antifungal drugs, leaving clinicians and patients in despair.