Efficacy of terbinafine for toenail onychomycosis. A multicenter trial of various treatment durations.

The efficacy of terbinafine (250 mg/day) in the treatment of toenail onychomycosis was evaluated in a large open-label, multicenter trial of 12, 18, and 24 weeks of therapy. All 1,534 patients had onychomycosis, confirmed by either positive potassium hydroxide (KOH) wet mount, positive fungal culture, or both, and all received at least 12 weeks of treatment. Treatment was continued for an additional 6 or 12 weeks, depending on the extent of the disease at follow-up. Mycologic cure rates (negative culture plus negative KOH) at week 72 were 72.1% in the 12-week treatment group, 72.5% in the 18-week group, and 77.0% in the 24-week group. In all groups, clinical cure rates were higher at week 72 than at week 48: 49.5% of the 12-week group, 49.2% of the 18-week group, and 44.6% of the 24-week group experienced clinical cure by the end of the study. Both mycologic and clinical recurrence rates were low in all treatment groups at the 72-week assessment. The results of this study confirm the efficacy of terbinafine in the treatment of toenail onychomycosis as demonstrated in previous registration and large-scale clinical trials.

L.I.ON. Study: efficacy and tolerability of continuous terbinafine (Lamisil) compared to intermittent itraconazole in the treatment of toenail onychomycosis. Lamisil vs. Itraconazole in Onychomycosis.

We undertook a prospective, randomised, double-blind, double-dummy, multicentre, parallel-group study to compare the efficacy and tolerability of continuous terbinafine (Lamisil) with intermittent itraconazole (Sporanox) in the treatment of toenail onychomycosis. A total of 496 patients (age range 18-75 years) with a clinical diagnosis of dermatophyte toenail onychomycosis, confirmed by positive mycological culture and microscopy (KOH), were recruited from 35 centres in six European countries. They were randomly divided into four parallel groups to receive either terbinafine 250 mg/day for 12 or 16 weeks (groups T12 and T16), or itraconazole 400 mg/day for 1 week in every 4 weeks for 12 or 16 weeks (groups I3 and I4). The primary efficacy measurement at week 72 was mycological cure, defined as negative microscopy and negative culture of samples from the target toenail. At week 72, the mycological cure rates were 75.5% (81/107) in the T12 group and 80.8% (80/99) in the T16 group, compared with 38.3% (41/107) in the I3 group and 49.1% (53/108) in the I4 group. All comparisons (T12 vs. I3, T12 vs. I4, T16 vs. I3, T16 vs. I4) showed significantly higher cure rates in the terbinafine groups (all P<0.0001). In addition, all secondary clinical outcome measures were significantly in favour of terbinafine at week 72. Both treatments were well tolerated, with no significant differences in the number or type of adverse events reported. We conclude that continuous terbinafine is significantly more effective than intermittent itraconazole in the treatment of toenail dermatophyte onychomycosis.

Safety of oral terbinafine for toenail onychomycosis.

This open-label multicenter study evaluated the safety and efficacy of 12, 18, and 24 weeks of daily treatment with a 250-mg tablet of terbinafine for onychomycosis of the toenails. The safety data for 1,508 patients with a mean age of 50 years are reported here. Percentages below are based on this denominator. All patients received at least 12 weeks of therapy, with a possible addition of 6 or 12 weeks depending on disease extent. Patients were evaluated at baseline and at weeks 6, 12, 24, 30, 36, 48, and 72. Adverse events were reported in 674 (44.7%) patients; the events were considered unrelated to terbinafine in 557 (36.9%) patients and causally related or of uncertain relationship to terbinafine in 117 (7.8%) patients. Most events involved the skin, the gastrointestinal system, or the respiratory system. Statistically similar results were found for the elderly (over 60 years) and diabetic subpopulations. The study results confirm the safety of terbinafine in the population at large and show no differences for either the elderly or diabetic patients, who are at increased risk for onychomycosis and who frequently take concomitant medications with potential for drug interactions.

The "nuisance" sexually transmitted diseases: molluscum contagiosum, scabies, and crab lice.

Although molluscum contagiosum, scabies, and infestation by crab lice do not carry the requirements of partner notification or other long-term consequences, they are among the most commonly reported sexually transmitted disease. Molluscum contagiosum is a benign viral infection of the skin epidermal layer, most often transmitted by intimate skin-to-skin contact. The lesions often resolve spontaneously over time, but patient discomfort or social reasons may require destructive removal of the lesions. Scabies is caused by the Sarcoptes scabiei mite. The victims continually itch, especially at night, and often seek over-the-counter topical remedies before seeing a clinician. Once a correct diagnosis is made, successful resolution of this disease and its itching can be achieved. Head and pubic lice account for most of the more than three million cases of louse infestation treated in the United States each year. Symptoms of infestation generally include itching that leads to scratching, erythema, irritation, and inflammation. A careful diagnosis followed by disinfection, symptomatic treatment, and psychologic support should result in a complete cure with no long-term effects.

Ceftriaxone penetration of tissues.

Ceftriaxone (Rocephin) has shown excellent tissue and body fluid penetration after a dose of 1-2 g: concentrations well above the minimal inhibitory concentrations of most pathogens responsible for infection are detectable for more than 24 h. Data from over 60 tissues were analyzed from the literature; a selection of comparative and noncomparative studies of clinical relevance is presented.

The retinoids in acne.

Vitamin A is essential for growth and development, reproduction and vision in humans. Chemical modification of vitamin A has yielded compounds showing therapeutic promise in skin and neoplastic diseases. The medicinal use of retinoids (vitamin A and its derivatives) is limited by the toxicity associated with this group of compounds. One retinoid, 13-cis-retinoic acid, has proved to be quite effective in the treatment of severe recalcitrant cystic acne under conditions in which toxicity is manageable.

Demographic study of head lice infestations in Sacramento County school children.

Head lice infestations have become a problem in school children in Sacramento County. An open study was conducted to determine how widespread head lice infestations were among preschool and elementary school children in Sacramento County and to see how effective a newly marked ever-the-counter pediculicide containing 0.3% pyrethrins synergized by 3.0% piperonyl butoxide was. The public health nurse for this study visited the homes of all reported patients infested with head lice. She verified and provided the pyrethrins-based treatment for 248 children, aged 6 months to 12 years. The children were Caucasian, Mexican-American, black and other ethnic backgrounds and from low, middle and upper income levels. All the patients were successfully treated, and the school children were able to return to their classs in a short time.

School-based immunization clinics. A method for raising community immunization levels.

A survey in ten Sacramento schools indicated that immunization levels were low and that they compared with the low levels estimated by the Center for Disease Control for the rest of the country. The problem was given priority, and a plan evolved using the community's schools.A method was developed to screen and immunize large numbers of children in a short time. The schools were used as a focal point to immunize both school-aged and preschool-aged children in each section of Sacramento County. A trained immunization team carried out immunizations with high cost effectiveness.