EFFECTIVENESS AND SAFETY OF TERBINAFINE 500 MG ONCE DAILY IN PATIENTS WITH RECALCITRANT AND RECURRENT DERMATOPHYTOSIS

Abstract

Background: Dermatophytosis is a superficial fungal infection of keratinized tissues and has a prevalence of 20-25 throughout the world. The treatment of recalcitrant and recurrent infections is problematic, and in many cases, because of antifungal resistance. Terbinafine is a frequently used antifungal agent (250 mg daily) which is an oral use of allylamine, although recent research may indicate resistance and recurrence. The higher dosing (500 mg daily) can have better results, but there is little information on efficacy and safety. Objective: To evaluate the efficacy and rate of side effects of terbinafine 500 mg single dose daily in individuals with recalcitrant and recurrent dermatophytosis. Methodology: The case series is a descriptive study that was done in Dermatology Unit I, KEMU/Mayo Hospital Lahore from September 2025 to January 2026. Sixty-two patients between 18 and 60 years of age with recalcitrant or recurrent dermatophytosis diagnosed by clinical analysis and KOH smear were recruited. The exclusion criteria were the use of antifungals recently, tinea unicum, pregnancy, lactation, immunocompromised, secondary bacterial infection, liver disease, or hypersensitivity to terbinafine. All the patients were treated with oral terbinafine 500 mg daily with topical clotrimazole 1% cream twice a day and oral cetirizine 10 mg once at bedtime. Clinical assessment (lesion count, pruritus, erythema, scaling) and liver function tests were done at a follow-up period of 2, 4, and 6 weeks. The criteria used to define effectiveness were ≥75% clinical treatment at 6 weeks; safety was measured in the form of adverse events. Analysis of data was done in SPSS 26. Results: By 6 weeks age, most patients had attained clinical cure and had reduced lesions and symptoms to a significant degree. The side effects were minor and short lived, such as gastrointestinal discomfort, headache, and taste disruption, and no severe side effects or permanent liver functional alterations. Conclusion: Terbinafine 500 mg in a single daily dose is a safe and effective therapeutic agent of recalcitrant and recurrent dermatophytosis. Increased dosage has the potential to surmount partial resistance to conventional 250 mg daily therapy and enhance clinical responses, with few adverse effects. Long-term safety and mycological cure rates are suggested to be proved by further randomized controlled trials.