End of the road for terbinafine? Think of compliance to treatment

Noureddine Litaiem¹ , Manel Karray¹ , Sabrine Bouhlel² , Takwa Bacha¹ , Faten Zeglaoui¹

¹ Department of Dermatology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
² Department of Parasitology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia

Correspondence Address:
Noureddine Litaiem
Department of Dermatology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis
Tunisia

Sir,

We read with interest the publication entitled “End of the road for terbinafine? Results of a pragmatic prospective cohort study of 500 patients.”^[1] In this paper, 500 patients diagnosed with dermatophytic infections (tinea corporis, tinea cruris and tinea faciei) were enrolled and prescribed oral terbinafine. After 4 weeks, the cumulative cure rate was low (30%) and the authors concluded that terbinafine is losing its efficacy.

The study conducted by Singh and Shukla^[1] is interesting because terbinafine has been considered for a long time as the treatment of choice for dermatophytic infections with high efficacy and tolerability.^[2],[3] The authors describe their study as being a pragmatic trial. Neither compliance to treatment nor in vitro assessment of antifungal resistance was analyzed.

We noticed similar low cure rates in Tunisia, concerning especially onychomycosis treated with terbinafine, and we performed a study trying to assess the reasons of treatment failure.

We conducted a prospective, descriptive and analytical study, enrolling all patients with mycologically proven hand and nail onychomycosis, between April 2016 and July 2017. Patients were treated according to the British guidelines.^[3] Onychomycosis related to dermatophytic fungi was confirmed in 184 patients and terbinafine was prescribed to 66.3% of them. Only 24, 3% of the patients, responded to treatment after 6 months.

In our study, when patients were interviewed about compliance to treatment, 30% of them revealed that they did not take any pill and 21% of them said they only received a treatment for <4 months. The leading reasons of poor therapeutic compliance were the excessive cost of the drug (55%), and the fear of related side effects (36.23%).

Therefore, more studies should be carried out to evaluate compliance to terbinafine and in vitro antifungal resistance before drawing the conclusion about the “end of the road for terbinafine.”^[4]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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