Comparison 6 Allylamines 12 weeks vs Azoles 12 weeks, Outcome 1 Short term (2 weeks) treatment failure. : {"type":"entrez-nucleotide","attrs":{"text":"CD012093","term_id":"30328831","term_text":"CD012093"}}CD012093. Azoles are also very effective and participants should be advised that although all azoles appear to be similarly effective, using an azole cream for four weeks is likely to produce better results than using it for one week. Noguera X, Goldfarb MT, All randomised controlled studies of topical treatment for fungal infections of the skin and nails of the foot. Comparison of once and twice daily Naftifine cream regimens with twice daily Clotrimazole in the treatment of tinea pedis. Of the 144 identified papers, 67 trials met the inclusion criteria. There is some evidence that ciclopiroxolamine and butenafine are both effective but they both need to be applied daily for prolonged periods (at least one year). Comparison 11 Comparisons between other topical antifungal treatments, Outcome 2 Medium term (6 weeks) treatment failure. ti,ab. Lopez S, Little data was available about the long term outcomes associated with the use of antifungal creams and there is uncertainty about rates of reinfection and relapse. Placebocontrolled trials yielded the following pooled risk ratios (RR) of treatment failure for skin infections: allylamines RR 0.33 (95% CI 0.24 to 0.44); azoles RR 0.30 (95% CI 0.20 to 0.45); ciclopiroxolamine RR 0.27 (95% CI 0.11 to 0.66); tolnaftate RR 0.19 (95% CI 0.08 to 0.44); butenafine RR 0.33 (95% CI 0.24 to 0.45); undecanoates RR 0.29 (95% CI 0.12 to 0.70). Pierini P, Topical treatments for fungal infections of the skin and nails of the foot. Patel A, The small trial of Whitfield's ointment and variotin applied for eight weeks only included ten people with athlete's foot and it is therefore unsurprising that the trialists failed to detect differences between these two compounds. Comparison between undeclynic acid and tolnaftate in the treatment of tinea pedis, Efficacy of miconazole in the topical treatment of tinea pedis in sportsmen. Datry A, Butenafine, ciclopiroxolamine, tolciclate and tolnaftate also showed greater effectiveness than placebo in the treatment of fungal skin conditions. To establish the effectiveness of topical treatments used for fungal infections of the skin and nails compared with other treatments or untreated controls. Garan M, 55. Allylamines versus azoles four to six weeks. Padila, One trial (n = 313, Korting 1997) evaluated 1% econazole gel versus 1% econazole cream but did not show a statistically significant difference in rates of treatment failure (RR of treatment failure = 0.78, 5% CI 0.53 to 1.16; Analysis 5.2). Naftifine twice daily Oxiconazole once versus twice daily The review did not find any evidence to support the use of tea tree oil in the management of athlete's foot. In the trial by Smith 1990b (n = 117) no statistically significant difference was observed at 2 weeks between naftifine used once daily or twice daily (RR of treatment failure at 2 weeks 0.92, 95% CI 0.72 to 1.17; Analysis 4.1). We searched MEDLINE (OVID) (from inception to January 2005) using the strategy in Appendix 3.
Bart BJ, These items are reported in the Characteristics of included studies. If you buy any medicines, always check with a pharmacist that they are safe to use with your other medicines. Trials directly comparing the two compounds demonstrate the superiority of allylamines. The ideal topical antifungal for the treatment of fungal infection should be fungicidal so that treatment can be of short duration, it should obtain high cure rates, minimise relapses, be conducive to participant compliance and have minimal adverse effects. Only >=80% followup included.. A L'Abb plot of the outcomes at six weeks (Figure 6) demonstrates a wide variation in observed treatment failure rates. 17. 2. Four trials compared the rate of treatment failure of different allylamines or allylamine regimens (all 1%, Ablon 1986; Bergstresser 1993; Evans 1994; Smith 1990b). Brautigam M, For major comparisons where overall pooling of the results was considered potentially appropriate, the results were also illustrated using L'Abb plots (L'Abbe 1985). (e) selective reporting; Comparison 8 Allylamines 46 weeks vs Azoles 46 weeks, Outcome 2 Medium term (6 weeks) treatment failure. Twentyfive trials compared two active treatment regimens (Bojanovsky 1985; Carter 1972; Del Palacio 1989; Evans 1993a; Evans 1993b; Friederich 1992; Haas 1985; Holti 1970; Kagawa 1985; Kligman 1985bKuhlwein 1990; Leenutaphong 1999; Plotkin 1990; Pereda 2003; Qadripur 1979; Roberts 1985; Sanchez 1994Schopf 1999Smith 1988b; Smith 1988c; Smith 1992; Sushka 2001; Vermeer 1996; Weller 1998; Woscoff 1986). There was considerable variation in the results of the individual trials (I2 = 68%) Six of those trials (Evans 1993a; Haas 1985; Kagawa 1985; Smith 1990a; Smith 1992) reported outcomes for at least 80% of those randomised (n = 896) and produced a relative risk of treatment failure of 0.55 (95% CI 0.34 to 0.89; Analysis 8.2) for the superiority of allylamines over azoles. et al. In the trial of 2% butenafine with 5% tea tree oil 93.3% of participants had no drugrelated negative side effects. Shortterm outcome was reported only in the four trials of bifonazole, and one trial of oxiconazole. (#22 or #23 or #24) Lucky A, Griffith RF, Bergstresser PR, Only >=80% followup included.. A L'Abb plot of the outcomes at 6 weeks (Figure 4) shows the allylamines had treatment failure rates of around 15% to 20%, compared to 50% to 70% for the azoles (Methods, Assessment of heterogeneity for more details of L'Abb plots and how to interpret them). Gorsulowsky DC, Clotrimazole 
Duncan WC. Protocol first published: Issue 1, 1999 Comparison 12 Treatments for onychomycosis (nail infections), Outcome 2 Comparisons between active treatments, treatment failure. government site. Side effects as measured by the frequency of reported adverse events. Only >=80% followup included.. Salicylic acid plus nitrate versus salicylic acid Dodman B, Weller R, et al. Jin L, Karvonen J. Efficacy and tolerability of terbinafine 1% emulsion gel in patients with tinea pedis, European Academy of Dermatology and Venereology, A double blind controlled trial of Whitfield's ointment and Variotin in ringworm infections with a two year 'followup, Once daily application of econazole nitrate in the treatment of tinea pedis, A double blind study of bifonazole 1% cream applied once daily in the treatment of tinea (pityriasis) veriscolor and tinea pedis interdigitalis, Comparative clinical trial of Naftifine and Clotrimazole in Tinea pedum, Tinea cruris and Tinea corporis, Antimycotic naftifine. A meta analysis of data collected in nine trials (n = 1003, Bergstresser 1993; Bojanovsky 1985; Evans 1993a; Haas 1985; Kagawa 1985; Plotkin 1990; Sanchez 1994; Smith 1990b; Smith 1992) found a statistically significant difference between 1% allylamines (naftifine, terbinafine) and 1% to 2% azoles (bifonazole, clotrimazole) used for 4 to 6 weeks, with a relative reduction in treatment failure of 37% favouring allylamines (RR 0.63, 95% CI 0.42 to 0.94; Analysis 8.1). To estimate differences between treatment regimens, we pooled trials that evaluated similar interventions. (b) nail maintenance of cure 36 weeks after initiation of intervention. The results from these labbased diagnostic tests can take up to several weeks to obtain, and often trial participants are randomised to an allocation and begin treatment before the test results are available. RESEARCH DESIGN.sh. Thorne EG. We identified 144 papers reporting trials of topical treatments for fungal skin infections and included 67 (Ablon 1996; Akers 1989; Aly 2003; Bagatell 1986; Bagatell 1991a; Bagatell 1991b; Bergstresser 1993; Berman 1992; Bojanovsky 1985; Carter 1972; Chretien 1980; Coffey 1986; Del Palacio 1989; Dobson 1989; Elewski 1996; Ellis 1989; Evans 1991; Evans 1993a; Evans 1993b; Evans 1994; Friederich 1992; Fuerst 1980; Gentles 1974; Gomez 1986; Haas 1985; Hollmen 2002; Holti 1970; Ison 1990; Izuno 1986; Kagawa 1985; Klaschka 1984; Kligman 1985a; Kligman 1985b; Korting 1997; Kuhlwein 1990; Ledezma 2000; Leenutaphong 1999; Mandy 1974; Pereda 2003; Plotkin 1990; Qadripur 1979; Roberts 1985; Sanchez 1994; Satchell 2002; Savin 1990; Savin 1994; Savin 1997; Schachner 1990; Schopf 1999; Smith 1977; Smith 1986; Smith 1988a; Smith 1988b; Smith 1988c; Smith 1990a; Smith 1990b; Smith 1992; Spiekermann 1976a; Spiekermann 1976b; Sushka 2001; Syed 2000; Tong 1992; Tschen 1997; Vermeer 1996; Weller 1998; Woscoff 1986; Zaug 1992). a. Huntley, Howard W, Harada T, Comparison 2 Azoles (tx 46 weeks) vs Placebo, Outcome 1 Short term (2 weeks) treatment failure. Comparative efficacy and safety of amorolfine nail laquer 5% in onychomycosis. Additionally, patches of hard thickened skin occur on the soles, heels and side of the feet. Evaluation of ciclopirox olamine cream for the treatment of tinea pedis: Multicentre double blind comparative studies. Oliver V, Bifonazole versus miconazole Fisher G, Comparison 9 Allylamines vs Other antifungal topical skin treatments, Outcome 2 Medium term (6 weeks) treatment failure. Ellis CN, Syed TA, The majority of available data demonstrate low cure rates after long treatment times with ciclopiroxolamine. In the trials of ciclopiroxolamine 8% nail lacquer adverse events considered by the investigator to be possibly related to the nail lacquer or vehicle were reported to be as follows: 16 participants in the ciclopiroxolamine group developed a rash compared to 3 participants in the vehicle group; 5 participants in the ciclopiroxolamine group developed nail disorders e.g. In the section 'Effects of interventions' part (b) Nails trials, the authors say "A comparison of 2% butenafine versus 5% tea tree oil produced a relative risk 0.03; 95% CI 0.00 to 0.47 at 36 weeks showing butenafine + tea tree oil to be statistically significantly more effective than tea tree oil alone (Syed 1999). 28. 46. et al. 51. For nail infections we included only trials that used culture to do so. Cintio R, Savin R, Bergman R, Data collected in the trial of terbinafine used for 57 days versus terbinafine used for 13 days (n = 65, Evans 1994) found slightly less treatment failures with 57 days treatment, but the difference was not statistically significant (RR of treatment failure at 12 weeks 0.53, 95% CI 0.15 to 1.88; Analysis 4.4). Hong S, et al. Becker LE, ( MICONAZOLE or DAKTARIN ) ti,ab,sh. We also excluded four trials evaluating a combination of systemic and topical treatments for infected nails (Arenas 1991; Baran 2000; Barnetson 1998; Friedman 1997; Zaug 1995). Ravichandran G, Large randomised controlled trials comparing the effectiveness of topical amorolfine and butenafine are needed to establish an alternative to oral treatments for toe nail infections. Lyddon FE. OR / 35 40 42. explode FOOT DERMATOSES/ 43. explode ONYCHOMYCOSIS/ 44. Clotrimazole four weeks versus clotrimazole one week The most effective topical agent was terbinafine. Experience with amorolfine in the treatment of dermatomycoses. All men and women of any age who have a fungal infection of the skin or nails of human foot which has been identified by microscopy and growth of dermatophytes in culture. 28 NOT 10 30. Evans EGV, We identified 11 trials evaluating the efficacy of topical treatments for nails and included 6 in the review (Buck 1994; Gupta 2000a; Gupta 2000b; Mensing 1992; Montana 1994; Syed 1999). As a result of the feedback received, Analysis 12.1 'Treatments versus placebo' was amended to include butenafine & tea tree oil versus placebo. Efficacy and safety of terbinafine 1% solution in the treatment of interdigital tinea pedis and tinea corporis or tinea cruris. Overall the observed relative reduction in risk of treatment failure was 25% (RR 0.75, 95% CI 0.60 to 0.93; Analysis 1.1), although there was substantial variation in the individual study results (I2 = 79%). The skin between the toes is a frequent site of fungal infection (athlete's foot or tinea pedis and this can cause pain and itchiness. Li M, Oxiconazole once per day versus oxiconazole twice per day Littlewood S, Hyperkeratotic chronic tinea pedis treated with neticonazole cream, Topical econazole versus terbinafine in the treatment of toe web space infections: a comparison, Amorolfine nail lacquer: clinical experiance in onychomycosis, Journal of European Academy of Dermatology and venereology. Comparison 6 Allylamines 12 weeks vs Azoles 12 weeks, Outcome 1 Short term (2 weeks) treatment failure. : {"type":"entrez-nucleotide","attrs":{"text":"CD012093","term_id":"30328831","term_text":"CD012093"}}CD012093. Azoles are also very effective and participants should be advised that although all azoles appear to be similarly effective, using an azole cream for four weeks is likely to produce better results than using it for one week. Noguera X, Goldfarb MT, All randomised controlled studies of topical treatment for fungal infections of the skin and nails of the foot. Comparison of once and twice daily Naftifine cream regimens with twice daily Clotrimazole in the treatment of tinea pedis. Of the 144 identified papers, 67 trials met the inclusion criteria. There is some evidence that ciclopiroxolamine and butenafine are both effective but they both need to be applied daily for prolonged periods (at least one year). Comparison 11 Comparisons between other topical antifungal treatments, Outcome 2 Medium term (6 weeks) treatment failure. ti,ab. Lopez S, Little data was available about the long term outcomes associated with the use of antifungal creams and there is uncertainty about rates of reinfection and relapse. Placebocontrolled trials yielded the following pooled risk ratios (RR) of treatment failure for skin infections: allylamines RR 0.33 (95% CI 0.24 to 0.44); azoles RR 0.30 (95% CI 0.20 to 0.45); ciclopiroxolamine RR 0.27 (95% CI 0.11 to 0.66); tolnaftate RR 0.19 (95% CI 0.08 to 0.44); butenafine RR 0.33 (95% CI 0.24 to 0.45); undecanoates RR 0.29 (95% CI 0.12 to 0.70). Pierini P, Topical treatments for fungal infections of the skin and nails of the foot. Patel A, The small trial of Whitfield's ointment and variotin applied for eight weeks only included ten people with athlete's foot and it is therefore unsurprising that the trialists failed to detect differences between these two compounds. Comparison between undeclynic acid and tolnaftate in the treatment of tinea pedis, Efficacy of miconazole in the topical treatment of tinea pedis in sportsmen. Datry A, Butenafine, ciclopiroxolamine, tolciclate and tolnaftate also showed greater effectiveness than placebo in the treatment of fungal skin conditions. To establish the effectiveness of topical treatments used for fungal infections of the skin and nails compared with other treatments or untreated controls. Garan M, 55. Allylamines versus azoles four to six weeks. Padila, One trial (n = 313, Korting 1997) evaluated 1% econazole gel versus 1% econazole cream but did not show a statistically significant difference in rates of treatment failure (RR of treatment failure = 0.78, 5% CI 0.53 to 1.16; Analysis 5.2). Naftifine twice daily Oxiconazole once versus twice daily The review did not find any evidence to support the use of tea tree oil in the management of athlete's foot. In the trial by Smith 1990b (n = 117) no statistically significant difference was observed at 2 weeks between naftifine used once daily or twice daily (RR of treatment failure at 2 weeks 0.92, 95% CI 0.72 to 1.17; Analysis 4.1). We searched MEDLINE (OVID) (from inception to January 2005) using the strategy in Appendix 3.
Comparison 6 Allylamines 12 weeks vs Azoles 12 weeks, Outcome 1 Short term (2 weeks) treatment failure. : {"type":"entrez-nucleotide","attrs":{"text":"CD012093","term_id":"30328831","term_text":"CD012093"}}CD012093. Azoles are also very effective and participants should be advised that although all azoles appear to be similarly effective, using an azole cream for four weeks is likely to produce better results than using it for one week. Noguera X, Goldfarb MT, All randomised controlled studies of topical treatment for fungal infections of the skin and nails of the foot. Comparison of once and twice daily Naftifine cream regimens with twice daily Clotrimazole in the treatment of tinea pedis. Of the 144 identified papers, 67 trials met the inclusion criteria. There is some evidence that ciclopiroxolamine and butenafine are both effective but they both need to be applied daily for prolonged periods (at least one year). Comparison 11 Comparisons between other topical antifungal treatments, Outcome 2 Medium term (6 weeks) treatment failure. ti,ab. Lopez S, Little data was available about the long term outcomes associated with the use of antifungal creams and there is uncertainty about rates of reinfection and relapse. Placebocontrolled trials yielded the following pooled risk ratios (RR) of treatment failure for skin infections: allylamines RR 0.33 (95% CI 0.24 to 0.44); azoles RR 0.30 (95% CI 0.20 to 0.45); ciclopiroxolamine RR 0.27 (95% CI 0.11 to 0.66); tolnaftate RR 0.19 (95% CI 0.08 to 0.44); butenafine RR 0.33 (95% CI 0.24 to 0.45); undecanoates RR 0.29 (95% CI 0.12 to 0.70). Pierini P, Topical treatments for fungal infections of the skin and nails of the foot. Patel A, The small trial of Whitfield's ointment and variotin applied for eight weeks only included ten people with athlete's foot and it is therefore unsurprising that the trialists failed to detect differences between these two compounds. Comparison between undeclynic acid and tolnaftate in the treatment of tinea pedis, Efficacy of miconazole in the topical treatment of tinea pedis in sportsmen. Datry A, Butenafine, ciclopiroxolamine, tolciclate and tolnaftate also showed greater effectiveness than placebo in the treatment of fungal skin conditions. To establish the effectiveness of topical treatments used for fungal infections of the skin and nails compared with other treatments or untreated controls. Garan M, 55. Allylamines versus azoles four to six weeks. Padila, One trial (n = 313, Korting 1997) evaluated 1% econazole gel versus 1% econazole cream but did not show a statistically significant difference in rates of treatment failure (RR of treatment failure = 0.78, 5% CI 0.53 to 1.16; Analysis 5.2). Naftifine twice daily Oxiconazole once versus twice daily The review did not find any evidence to support the use of tea tree oil in the management of athlete's foot. In the trial by Smith 1990b (n = 117) no statistically significant difference was observed at 2 weeks between naftifine used once daily or twice daily (RR of treatment failure at 2 weeks 0.92, 95% CI 0.72 to 1.17; Analysis 4.1). We searched MEDLINE (OVID) (from inception to January 2005) using the strategy in Appendix 3.