A comparative study on efficacy of oral terbinafine and itraconazole on dermatophytic infections

Govind Kumar, Kshitij Saxena, V. Rao Koti


Background: The increased cases of dermatophyte infections and their poor response to oral drugs with current doses and duration of treatment is common. So, we conducted the study with a goal to assess the efficacies of two antifungal drugs with their increased dosages and duration. 

Methods: A prospective comparative study was done on 145 patients belonging to age group 18-60 years which were both clinically and microbiologically confirmed cases of tinea cruris and tinea corporis. Patients were randomized into two groups A and B. Group A patients were given capsule itraconazole 100 mg twice daily and group B were given tablet terbinafine 250 mg twice daily, both for 6 weeks. Patients were followed up at 2, 4 and 6 week and at each visit, scores for 3 parameters (erythema, scaling and pruritus) were recorded and were analysed.

Results: A total 140 patients completed the study with 72 patients in group A and 73 patients in group B. In group A 72.5% patients achieved complete remission compared to 67.6% in group B. At each follow up patients were evaluated based on total symptom score (erythema, scaling and pruritus) which had shown significant improvement with negative potassium hydroxide results. None of the patients had severe side effects.

Conclusions: Study showed that Itraconazole has higher clinical and mycological cure rates as compared to terbinafine. So itraconazole is superior to terbinafine in treatment of tinea corporis and cruris.


Dermatophyte, Tinea, Itraconazole, Terbinafine

Full Text:



Dismukes WE, Pappas PG, Sobel JD. Clinical Mycology. USA: Oxford University press. 2003.

AL-Janabi AA. Dermatophytosis: Causes, clinical features, signs and treatment. J Sympt Signs. 2014;3:200-3.

Al Sheikh H. Epidemiology of dermatophytes in the Eastern province of Saudi Arabia. Res J Microbiol. 2009;4:229-39.

Ismael HM. Isolation and identification of dermatophytes and other fungal agents from clinical specimens in Erbil city. 2nd Scientific Conference for Biological Science-Science College-Mosul University. 2011;16:407-18.

Seebacher C, Bouchara J-P, Mignon B. Updates on the Epidemiology of Dermatophyte. Infections. 2008;166(5-6):335-2.

De Beule K, Van Gestel J. Pharmacology of itraconazole. Drugs. 2001;61(1):27-37.

Elewski B, Tavakkol A. Safety and tolerability of oral antifungal agents in the treatment of fungal nail disease: a proven reality. Ther Clin Risk Manag. 2005;1(4):299-306.

Lestner JM, Roberts SA, Moore CB. Toxicodynamics of itraconazole: implications for therapeutic drug monitoring. Clin Infect Dis. 2009;49:928-30.

Elewski B, Tavakkol A. Safety and tolerability of oral antifungal agents in the treatment of fungal nail disease: a proven reality. Ther Clin Risk Manag. 2005;1(4):299-306.

Maxfield L, Preuss CV, Bermudez R. Terbinafine. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. Available at: https://www.ncbi. Accessed on 2021 February 17.

Shi TW, Zhang JA, Zhang XW, Yu HX, Tang YB, Yu JB. Combination treatment of oral terbinafine with topical terbinafine and 10% urea ointment in hyperkeratotic type tinea pedis. Mycoses. 2014;57:560-4.

Li RY, Wang AP, Xu JH, Xi LY, Fu MH, Zhu M, et al. Efficacy and safety of 1% terbinafine film-forming solution in Chinese patients with tinea pedis: A randomized, double-blind, placebo-controlled, multicenter, parallel-group study. Clin Drug Investig. 2014;34:223-30.

Babu PR, Pravin A, Deshmukh G, Dhoot D, Samant A, Kotak B. Efficacy and safety of terbinafine 500 mg once daily in patients with dermatophytosis. Indian J Dermatol. 2017;62:395-9.

Shivakumar V, Okade R, Rajkumar V, Sajitha K, Prasad SR. Intermittent pulse-dosed terbinafine in the treatment of tinea corporis and/or tinea cruris. Indian J Dermatol. 2011;56(1):121-2.

Saul A, Bonifaz A. Itraconazole in common dermatophyte infections of the skin: fixed treatment schedules. J Am Acad Dermatol. 1990;23(3Pt 2):554-8.

Boonk W, de Geer D, de Kreek E, Remme J, van Huystee B. Itraconazole in the treatment of tinea corporis and tinea cruris: comparison of two treatment schedules. Mycoses. 1998;41(11-12):509-14.

Shakya N, Jha S, Dangol A, Shakya S, Shah A. Efficacy of Itraconazole Versus Terbinafine for the Treatment of Tineacruris. Med J Shree Birendra Hospital. 2013;11(1):24-6.

Ankani BTS. A Comparative Study of Itraconazole and Terbinafine in the Treatment of Onycomycosis. J. Pharm Sci Res. 2015;7(8):542-4.

Majid I, Sheikh G, Kanth F, Hakak R. Relapse after Oral Terbinafine Therapy in Dermatophytosis: A Clinical and Mycological Study. Indian J Dermatol. 2016;61(5):529-33.

Babu PR, Pravin A, Deshmukh G, Dhoot D, Samant A, Kotak B. Efficacy and safety of terbinafine 500 mg once daily in patients with dermatophytosis. Indian J Dermatol. 2017;62:395-9.

Singh S, Shukla P. End of the road for terbinafine? Results of a pragmatic prospective cohort study of 500 patients. Indian J Dermatol Venereol Leprol. 2018;84:554-7.

Momin W, Vupperla D. Clinical Efficacy of Oral Terbinafine, Fluconazole and Itraconazole in the Treatment of Tinea Corporis. Asian J Res Dermatological Sci. 2018;1(1):1-10.

Bhatia A, Kanish B, Badyal DK, Kate P, Choudhary S. Efficacy of oral terbinafine versus itraconazole in treatment of dermatophytic infection of skin-A prospective, randomized comparative study. Indian J Pharmacol. 2019;51(2):116-9.

George M, Chaudhary RG, Rana D, Kasundra D, Chaudhary AR, Malhotra SD. Comparative evaluation of efficacy of terbinafine and itraconazole in treatment of tinea cruris. Int J Basic Clin Pharmacol. 2019;8:1460-6.

Wahiduzzaman M, Hoque MM, Sultana R, Husain MA, Mondal KJ. Comparative Efficacy of Terbinafine and Itraconazole on Fluconazole Resistant Tinea Corporis and Tinea Cruris Handling. Int J Med Res Prof. 2019;5(2):179-81.

Sharma P, Bhalla M, Thami GP, Chander J. Evaluation of efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis. J Dermatolog Treat. 2020;31(7):749-53.

Salunke P, Someshwar S, Bhobe M. Efficacy of daily oral terbinafine versus pulse fluconazole therapy in the treatment of tinea corporis, tinea cruris, and tinea faciei: A comparative study. MGM J Med Sci. 2020;7:10-5.

Singh SK, Subba N, Tilak R. Efficacy of terbinafine and itraconazole in different doses and in combination in the treatment of tinea infection: A randomized controlled parallel group open labeled trial with clinico-mycological correlation. Indian J Dermatol. 2020;65:284-9.

Shah B, Shah S, Jangid N, Dhoot D, Deshmukh G, Barkate H. Comparative evaluation of efficacy and safety of terbinafine and itraconazole in the management of tinea corporis et cruris. IP Indian J Clin Exp Dermatol. 2020;6(3):231-6.

Singh S, Chandra U, Anchan VN, Verma P, Tilak R. Limited effectiveness of four oral antifungal drugs (fluconazole, griseofulvin, itraconazole and terbinafine) in the current epidemic of altered dermatophytosis in India: results of a randomized pragmatic trial. Br J Dermatol. 2020;183(5):840-6.

Koregol SC, Naik SR, Hosthota A, Koregol AC. A comparative study of efficacy of oral itraconazole, terbinafine and fluconazole: a clinical trial. Int J Res Dermatol. 2021;7:435-9.

Brigida S, Elizabeth A. A Comparative Study of Efficacy of Oral Terbinafine and Oralitraconazole in Tinea Corporis/Tinea Cruris Infection. J Pharmaceutical Res Int. 2021;33(20A):94-105.

Osborne CS, Leitner I, Favre B, Ryder NS. Amino acid substitution in Trichophyton rubrum squalene epoxidase associated with resistance to terbinafine. Antimicrobial Agents Chemother. 2005;49:2840-4.