ITRACONAZOLE FOR THE TREATMENT OF ONYCHOMYCOSIS

Background The broad spectrum of activity of itraconazole in vitro man ifests itself clinically with the drug being effective for the treatme nt of onychomycosis caused by dermatophytes, Candida and some non-derm atophyte molds. The pharmacokinetics of itraconazole in the nail resul ts in drug remaining at therapeutic levels for 6-9 months after comple tion of therapy. Methods An overview of studies where continuous or pu lse itraconazole therapy has been used in the treatment of fingernail and toenail onychomycosis. Results Following continuous therapy at 200 mg/day for 3 months for toenail onychomycosis (n = 1741), the rates o f clinical cure, clinical response and mycologic cure were: (meta-aver age +/- 95% standard error (SE)), 52 +/- 9%, 86 +/- 2%, and 74 +/- 3%, respectively, at follow-up 12 months following start of therapy. In f ingernail onychomycosis (n = 211), the duration of therapy was 6 weeks acid the corresponding efficacy rates at follow-up, 9 months after st art of therapy, were meta-average (+/- S.E.) 82 +/- 5%, 90 +/- 2%, and 86 +/- 3%, respectively. In toenail onychomycosis treated with 3 puls es of therapy (n = 1389), the clinical response, clinical cure and myc ologic cure were observed in meta-average (+/- S.E.) 58 +/- 10%, 82 +/ - 3%, and 77 +/- 5% patients, respectively, at follow-up 12 months aft er the start of therapy. In fingernail onychomycosis treated with 2 pu lses of therapy (n = 210), at follow-up 9 months after the start of th erapy, the corresponding efficacy rates were meta-average (+/- S.E.) 7 8 +/- 10%, 89 +/- 6%, and 87 +/- 8%, respectively. Conclusions Both th e continuous and pulse therapy regimens are safe with few adverse effe cts. Compared to continuous therapy, the pulse regimen has an improved adverse effects profile, is more cost-effective, and is preferred by many patients.