Combination therapy consisting of week pulses of oral terbinafine plus topical application of terbinafine cream in the treatment of onychomycosis

BACKGROUND: Terbinafine, based on its pharmacokinetic properties, is a good candidate for pulse therapy. There are, as yet, no current guidelines for a terbinafine 1-week pulse regimine. OBJECTIVE: To determine the optimal 1-week pulse dosing regimen for combination therapy of oral terbinafine with complementary 1% terbinafine cream for the treatment of onychomycosis. DESIGN: A total of 69 onychomycosis patients received 250 mg terbinafine, given orally once daily for 7 days as 1-week pulses, separated by intervals of 2-3 weeks, until the desired improvement was observed. A daily application of 1% terbinafine cream was advised through to the evaluation date at 12 months follow-up. The treatment regimens were compared based on the number of pulses and the duration of treatment. RESULTS: The 45 patients (65.2%) who achieved complete cure received an average of 7.8+/-3.5 pulse treatments over 4.8+/-2.6 months. The optimal terbinafine dosing regimen consisted of alternate 1-week pulses, with most patients on this regimen (19/20 cases; 95%) achieving total cure. CONCLUSION: Favorable treatment outcome was gained from this terbinafine 1-week pulse regimen and also better compliance compared with a standard daily regimen.