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Oral treatments for fungal infections of the skin of the foot

机译：足部皮肤真菌感染的口服治疗

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BACKGROUND: About 15% of the world population have fungal infections of the feet (tinea pedis or athlete's foot). There are many clinical presentations of tinea pedis, and most commonly, tinea pedis is seen between the toes (interdigital) and on the soles, heels, and sides of the foot (plantar). Plantar tinea pedis is known as moccasin foot. Once acquired, the infection can spread to other sites including the nails, which can be a source of re-infection. Oral therapy is usually used for chronic conditions or when topical treatment has failed. OBJECTIVE: To assess the effects of oral treatments for fungal infections of the skin of the foot (tinea pedis). METHODS: Search methods: For this update we searched the following databases to July 2012: the Cochrane Skin Group Specialized Register, CENTRAL in The Cochrane Library, MEDLINE (from 1946), EMBASE (from 1974), and CINAHL (from 1981). We checked the bibliographies of retrieved trials for further references to relevant trials, and we searched online trials registers. Selection criteria: Randomized controlled trials of oral treatments in participants who have a clinically diagnosed tinea pedis, confirmed by microscopy and growth of dermatophytes (fungi) in culture. Data collection and analysis: Two review authors independently undertook study selection, "Risk of bias" assessment, and data extraction. MAIN RESULTS: We included 15 trials, involving 1,438 participants. The 2 trials (71 participants) comparing terbinafine and griseofulvin produced a pooled risk ratio (RR) of 2.26 (95% confidence interval (CI) 1.49 to 3.44) in favors of terbinafine's ability to cure infection. No significant difference was detected between terbinafine and itraconazole, fluconazole and itraconazole, fluconazole and ketoconazole, or between griseofulvin and ketoconazole, although the trials were generally small. Two trials showed that terbinafine and itraconazole were effective compared with placebo: terbinafine (31 participants, RR 24.54, 95%CI 1.57 to 384.32) and itraconazole (72 participants, RR 6.67, 95%CI 2.17 to 20.48). All drugs reported adverse effects, with gastrointestinal effects most commonly reported. Ten of the trials were published over 15 years ago, and this is reflected by the poor reporting of information from which to make a clear "Risk of bias" assessment. Only one trial was at low risk of bias overall. The majority of the remaining trials were judged as "unclear" risk of bias because of the lack of clear statements with respect to methods of generating the randomization sequence and allocation concealment. More trials achieved blinding of participants and personnel than blinding of the outcome assessors, which was again poorly reported. AUTHORS' CONCLUSIONS: The evidence suggests that terbinafine is more effective than griseofulvin; and terbinafine and itraconazole are more effective than no treatment. In order to produce more reliable data , a rigorous evaluation of different drug therapies needs to be undertaken with larger sample sizes to ensure they are large enough to show any real difference when two treatments are being compared. It is also important to continue to follow up and collect data , preferably for six months after the end of the intervention period, to establish whether or not the infection recurred.
机译：背景：世界上约有15％的人患有脚（脚癣或脚癣）的真菌感染。足癣的临床表现很多，最常见的是，足趾位于脚趾之间（趾间）以及脚底，脚跟和脚的侧面（足底）。足底癣称为鹿皮脚。一旦获得，感染可传播到其他部位，包括指甲，这可能是再次感染的来源。口服疗法通常用于慢性疾病或局部治疗失败时。目的：评估口服治疗对足部皮肤（脚癣）真菌感染的效果。方法：搜索方法：对于此次更新，我们搜索了截至2012年7月的以下数据库：Cochrane皮肤组专门注册机构，Cochrane图书馆中的CENTRAL，MEDLINE（从1946年开始），EMBASE（从1974年开始）和CINAHL（从1981年开始）。我们检查了检索到的试验的参考书目，以进一步参考相关试验，并搜索了在线试验记录。选择标准：经临床诊断为足癣的参与者的口服治疗的随机对照试验，通过显微镜检查和培养中皮肤真菌的生长进行确认。数据收集和分析：两位评价作者独立进行研究选择，“偏倚风险”评估和数据提取。主要结果：我们纳入了15个试验，涉及1,438名参与者。两项比较特比萘芬和灰黄霉素的试验（71名参与者）产生了2.26（95％置信区间（CI）1.49至3.44）的合并风险比（RR），有利于特比萘芬治疗感染的能力。尽管试验规模较小，但在特比萘芬和伊曲康唑，氟康唑和伊曲康唑，氟康唑和酮康唑，灰黄霉素和酮康唑之间未发现显着差异。两项试验表明特比萘芬和伊曲康唑与安慰剂相比有效：特比萘芬（31名受试者，RR 24.54，95％CI 1.57至384.32）和伊曲康唑（72名受试者，RR 6.67，95％CI 2.17至20.48）。所有药物均报告有不良反应，其中胃肠道反应最常见。其中有10项试验是在15年前发布的，这反映在信息报告不力，无法做出清晰的“偏倚风险”评估上。仅有一项试验总体上偏倚风险低。由于缺乏关于生成随机序列和分配隐藏的方法的明确陈述，其余大多数试验被判定为存在“不清楚”的偏倚风险。与结果评估者的盲目性相比，更多的试验使参与者和人员蒙蔽了盲目性，这再次被不良报道。作者的结论：证据表明特比萘芬比灰黄霉素更有效。特比萘芬和伊曲康唑比没有治疗更有效。为了获得更可靠的数据，需要对具有更大样本量的不同药物疗法进行严格的评估，以确保它们足够大，以便在比较两种疗法时显示出任何实际差异。同样重要的是，要继续进行随访并收集数据，最好是在干预期结束后的六个月内，以确定感染是否再次发生。

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