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Oral treatments for fungal infections of the skin of the foot.

  1. Sally EM Bell-Syer1,*,
  2. Rachel Hart2,
  3. Fay Crawford3,
  4. David J Torgerson4,
  5. Wendy Tyrrell2,
  6. Ian Russell5

Editorial Group: Cochrane Skin Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 4 DEC 2001

DOI: 10.1002/14651858.CD003584

Database Title

Additional Information

How to Cite

Bell-Syer SEM, Hart R, Crawford F, Torgerson DJ, Tyrrell W, Russell I. Oral treatments for fungal infections of the skin of the foot.. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD003584. DOI: 10.1002/14651858.CD003584.

Author Information

  1. 1

    University of York, Department of Health Sciences, York, North Yorkshire, UK

  2. 2

    University of Wales Institute, Faculty of Community Health Sciences, Cardiff, Wales, UK

  3. 3

    The University of Edinburgh, Division of Community Health Sciences, Edinburgh, UK

  4. 4

    University of York, Department of Health Sciences , York, North Yorkshire, UK

  5. 5

    University of Wales Bangor, Institute of Medical and Social Care Research, Bangor, Gwynedd, Wales, UK

*Sally EM Bell-Syer, Department of Health Sciences, University of York, Area 2 Seebohm Rowntree Building, Heslington, York, North Yorkshire, YO10 5DD, UK. sembs1@york.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

足部皮膚黴菌感染的口服藥物治療

大約15% 的人口有足部黴菌感染的問題，也就是所謂的足癬，或是運動員足 (香港腳) 。即便它有許多的臨床表現，它最常見的位置仍是在趾縫間、腳掌、腳跟，以及腳的側面，亦被稱為鹿皮軟鞋足。一旦被感染了足部，它可能漫延到其它部位，例如趾甲，而且這往往會是足部再次感染的來源。口服藥治療往往用在長期感染，或是外用治療無效時使用。

目標

評估在足癬病人使用口服抗黴菌藥的效果與花費。

搜尋策略

隨機對照試驗從下列資料庫自一開始至西元兩千年後一月後的資料被選取出來:MEDLINE, EMBASE and CINAHL。我們同時也搜索考科藍資料庫中Register (Cochrane Library issue 1, 2000) the Science Citation Index, BIOSIS, CABHealth, Health star and Economic databases。同時搜索相關書目，足部雜誌，也聯絡藥業及足部醫院。

選擇標準

隨機對照試驗包含了臨床上被診斷為足癬的病人，同時經由顯微鏡或黴菌培養證實。

資料收集與分析

研究的選擇、方法學的品質評估及資料收集都是由兩名獨立審核員完成。

主要結論

一共12試驗，700名參與者，被包含在這篇回顧。兩個比較terbinafine及griseofulvin的試驗顯示了terfinafine有52% 更佳的治療效果 (95% 信賴區間33% to 71%) 。在terbinafine和itraconazole的比較，fluconazole及 itraconazole或ketoconazole的比較，及griseofulvin與ketoconazole的比較，則都沒有明顯差別，但是這些試驗的規模都很小。有兩個試驗顯示terbinafine及itraconazole都較安慰劑組有效。所有藥物都有副作用的報告，最常發生的是腸胃道副作用。

作者結論

證據顯示terbinafine較griseofulvin有效。而terbinafine和itraconazole都比沒有治療有效。

翻譯人

本摘要由馬偕醫院謝志偉翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

口服抗黴菌藥對足癬是相當有效的治療，但它們會造成腸胃道的不舒服，同時它們的價錢昂貴。足癬是一種足部的黴菌感染，容易傳播且不易治療。這篇回顧比較了不同的口服抗黴菌藥，發現了terbinafine和itraconazole都比沒有治療有效。且Terbinafine和griseofulvin相比，作用快且更有效但價格較昂貴。但其它的藥物比較由於病人數太少，並不能顯示哪一種較佳。所有藥物都有副作用，最常發生的是腸胃道副作用。不同治療方式的成本與效果的分析比較則需要進一步的研究。

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