Terbinafine for fungal infections of the skin of the foot

Hannele Heikkilä and Ilona Mikkola

Level of evidence: B

Terbinafine appears to be effective for fungal infection of the skin of the foot.

A Cochrane review «Bell-Syer SE, Khan SM, Torgerson DJ. Oral treatmen...»1 included 15 trials, involving 1438 participants of any age, who have a fungal infection of the skin of the foot that has been clinically diagnosed and confirmed by microscopy and growth of dermatophytes in culture. Eleven trials reported the clinical type of tinea pedis (4 trials moccasin type tinea pedis; 3 trials plantar type tinea pedis; and 6 trials either mixed presentations of tinea pedis along with tinea cruris and tinea corporis or simply reported 'tinea pedis' with no further information). The type of tinea pedis did not appear to influence response to oral antifungal treatment.

Two trials (71 participants) compared terbinafine and griseofulvin. One trial compared terbinafine with placebo (31 participants). In all trials, terbinafine was given at the dose of 250 mg per day, but the treatment duration for terbinafine varied from 2 to 6 weeks, with the most frequent being 2 weeks

Primary outcome was the mycological cure demonstrated by negative results on microscopy and no growth of dermatophyte in culture. Comparing terbinafine and griseofulvin produced a pooled risk ratio (RR) of 2.26 (95 % confidence interval (CI) 1.49 to 3.44) in favour of terbinafine's ability to cure infection. One trial showed that terbinafine was effective compared with placebo (31 participants, RR 24.54, 95 % CI 1.57 to 384.32).

  • Study quality: High
  • Applicability: Good
  • Comment: The quality of evidence is downgraded by study limitations of original trials (unclear risk of bias) and due to inaccuracy of the outcomes.


  1. Bell-Syer SE, Khan SM, Torgerson DJ. Oral treatments for fungal infections of the skin of the foot. Cochrane Database Syst Rev 2012;10:CD003584 «PMID: 23076898»PubMed