AZOLES
Place in Therapy
After reviewing the literature, the azole class of anti-fungals (clotrimazole and miconazole) can be used as a first-line agent or as an alternative agent after tolnaftate or undecanoic acid treatment failure for athlete’s foot1,2. They should be tried before the use of the allyamines1,3.
Efficacy
The general consensus for azole therapy is to have at least a 4 week treatment to achieve a successful outcome3. They have lower relapse rates and show benefit for symptom improvement during therapy4. Even against the prescription allyamine class, azoles had similar or slightly lower risk of treatment failure1,3,5. Against placebo, this class of anti-fungals consistently showed an improvement in the condition3. They have been shown to be as effective against tinea pedis as undecenoic acid, but more effective than agents such as tolnaftate and tea tree oil3.
Safety
Numerous randomized controlled trials and systematic reviews report that only local irritation develops with the use of azole anti-fungal creams5. In some instances, this irritation is severe enough to discontinue treatment, but the incidence is rare5.
References
References:
1. Hart R et al. Systematic review of topical treatments for fungal infections of the skin and nails of the feet. BMJ 1999; 319: 79 – 82.
2. Ongley R. Efficacy of topical miconazole in the treatment of tinea pedis. CMAJ. 1978; 119: 353 – 354.
3. Crawford F and Hollis S. Topical treatments for fungal infections of the skin and nails of the foot. Cochrane Database of Systematic Reviews. 2007; 3: 1 – 155.
4. Suschka S et al. Clinical comparison of the efficacy and tolerability of once daily Canesten with twice daily Nizoral (clotrimazole 1% cream vs. ketoconazole 2% cream) during a 28-day topical treatment of interdigital tinea pedis. Mycoses. 2002; 45: 91 – 96.
5. Crawford F et al. Athlete’s Foot and Fungally Infected Toenails. BMJ. 2001; 322: 288 – 289