PULSE THERAPY WITH ONE-WEEK ITRACONAZOLE MONTHLY FOR 3 OR 4 MONTHS INTHE TREATMENT OF ONYCHOMYCOSIS

In an open study, twenty-eight patients with toenail onychomycosis wer e treated with monthly cycles of 400 mg itraconazole daily for one wee k for three (n=5) or four (n=23) consecutive months, In this patient s ample, a total of seventy-one toenails were affected, with a mean nail -plate involvement of 55 percent (range, 20 to 100 percent), Trichophy ton rubrum was the most frequently isolated pathogen, followed by T. m entagrophytes. After active therapy, patients were evaluated for a max imum period of two years (mean, twelve months). A total of twenty-six of twenty-eight patients (93 percent) were considered as clinically cu red. Of the remaining two patients, one was markedly improved and one appeared to have relapsed, Only three of seventy-one nails still exhib ited some pathologic involvement. Of the twenty-six patients considere d cured, mycologic examination at the final visit was performed on thi rteen and the results were negative in all of them, The remaining clin ically cured patients had no mycologic examination at the last visit. This short treatment was well tolerated; the only adverse reaction bei ng a mild headache in one patient. Patients preferred this regimen to receiving daily treatment for three months. Pulse therapy consisting o f monthly one-week cycles of 400 mg itraconazole daily for three to fo ur months may offer a new option for treatment of onychomycosis, Furth er large-scale studies are required to confirm these findings.