A systematic review of oral treatments for fungal infections of the skin of the feet.
OBJECTIVE
To synthesize the evidence for the effectiveness and cost-effectiveness of oral treatments for fungal infections of the skin of the feet.


METHODS
Systematic review.


METHODS
Oral treatments for fungal infections.


METHODS
Ten electronic databases, four journals and the bibliographies of all review papers identified were searched. The authors also wrote to international pharmaceutical companies and all podiatry schools in the UK. The studies selected were randomized trials of clinically diagnosed fungal skin infections of the foot that confirmed cure by culture and microscopy. Two reviewers independently selected trials and abstracted data using a structured tool including 12 recognized quality criteria.


RESULTS
Of 26 trials identified, 12 met the inclusion criteria and evaluated five different treatments. Single placebo-controlled trials showed that terbinafine and itraconazole were both effective. Two trials showed that terbinafine cures 50% more patients than griseofulvin. Four trials compared terbinafine with itraconazole, one showed that terbinafine given for 2 weeks had a better cure rate than 2 weeks of itraconazole, but the other three showed that it was no better than 4 weeks of itraconazole.


CONCLUSIONS
There is significant evidence that terbinafine is more effective than griseofulvin, though more costly. There is weak evidence that terbinafine may be more cost-effective than itraconazole. Firm recommendations about the choice between terbinafine and the azoles need further research.
Bell-Syer
S E
SE
Department of Health Studies and Centre for Health Economics, University of York, UK. sembs1@york.ac.uk
Hart
R
R
Crawford
F
F
Torgerson
D J
DJ
Young
P
P
Tyrrell
W
W
Williams
H
H
Russell
I
I
D000284:Administration, Oral; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D006801:Humans; D014008:Tinea Pedis / Q000188:drug therapy* / Q000191:economics
D000935:Antifungal Agents