Comparative Study of Side Effects Associated with Different Oral Antifungal Regimens in Patients with Superficial Dermatophytosis

Background: Superficial dermatophytosis is among the commonest fungal infections found across the globe with rising incidences of chronicity, recurrences, and resistance to therapy, especially in India. Systemic antifungal medications like Itraconazole, Terbinafine, and Fluconazole are commonly prescribed for the treatment of extensive and recurrent cases of dermatophytosis; but long-term administration of these drugs can result in toxicities to the liver, kidneys, blood cells, electrolytes, and the heart. The aim is to conduct a comparative study on the toxicity profiles of systemic Itraconazole, Terbinafine, and Fluconazole for the management of superficial dermatophytosis. Material and Methods: In this prospective observational comparative study, patients were randomly distributed between 3 groups Itraconazole, Terbinafine, and Fluconazole in tertiary care hospital, at TMU Hospital and Research for 4 weeks. There biochemical and clinical profile was evaluated to understand the side effects of these oral antifungal drugs. Results: No differences were seen between the three medication groups at baseline regarding haematology, biochemistry, kidney function, and liver function parameters. The only differences that were noted were in baseline serum sodium (p = 0.010) and serum chloride (p = 0.048), which were within the physiological normal range. At follow up, there was no difference between the three drug groups in hemoglobin levels, white cell count, platelets count, renal function markers, liver enzymes, bilirubin, serum electrolytes, or blood pressure measures (all p > 0.05). A minimal increase in the mean diastolic blood pressure was seen in the itraconazole group at follow up but this was not statistically significant. Conclusion: All three antifungals were effective and safe in the treatment of patients with Superficial Dermatophytosis.

Keywords: Superficial dermatophytosis; itraconazole; terbinafine; fluconazole; adverse effects; safety profile.