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Fungal skin infection - body and groin - Management
Which oral antifungal should I prescribe?

  • If an oral antifungal is appropriate (see Treatment), prescribe terbinafine, griseofulvin, or itraconazole.
  • Oral terbinafine:
    • Treatment duration is often shorter than with griseofulvin.
    • There are fewer drug interactions with terbinafine than with itraconazole.
    • Adverse effects are usually mild or transient, although there are concerns about liver toxicity.
  • Oral griseofulvin (licensed):
    • Is used less commonly following the introduction of newer, safer azoles (itraconazole and fluconazole) and terbinafine.
    • Women of childbearing age should be advised to avoid pregnancy during, and for 1 month after, treatment with griseofulvin. Men should ensure contraceptive precautions are taken during, and for the 6 months after, their own treatment due to potential adverse effects on the male reproductive system.
    • Griseofulvin is a fungistatic drug. It must be given continuously for a relatively long period of time, which may contribute to reduced compliance and decreased effectiveness.
  • Oral itraconazole:
    • Itraconazole is not recommended for use in children or elderly people because of a lack of data on its safety and efficacy in these groups.
    • Rare cases of serious hepatotoxicity have been reported.
    • The Committee on Safety of Medicines has advised caution when prescribing itraconazole to people at high risk of heart failure (for example older people, those with cardiac disease, people receiving negative inotropic drugs such as calcium-channel blockers, and people receiving high doses or long treatment courses of itraconazole).
  • Oral fluconazole and oral ketoconazole are not recommended.

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