All information is correct at time of printing and is subject to change without notice. The Devon Formulary and Referral Website is not in any way liable for the accuracy of any information printed and stored by users. For the most up-to-date information, please refer to the website.
Formulary
Contact us about this page
Management of dermatophyte infection
Invasive Group A Streptococcal infections have increased in incidence and need to be assessed rapidly in hospital. Maintain a high index of suspicion in patients with a high fever, severe muscle aches, confusion, unexplained D&V, local muscle tenderness, or severe pain out of proportion to external signs, hypotension, a flat red rash over large area of the body, conjunctival suffusion. |
Skin: Localised infection
The use of OTC dusting powders can be recommended to help prevent re-infection of athlete's foot.
| SELF-CARE: NHS England has published guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care. These conditions include ringworm, athlete's foot, and nappy rash. Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. |
Oral therapy is indicated in scalp infection, discuss with specialist.
Terbinafine is fungicidal and the treatment time is shorter than with fungistatic imidazoles.
Terbinafine 1%
- Topical: apply every 12 hours for 1-2 weeks after healing (i.e. 4-6 weeks)
Miconazole 2%
- Topical: apply every 12 hours for 1-2 weeks after healing (i.e. 4-6 weeks)
Skin: Extensive infection or failure to respond to topical anti-fungal
Take skin scrapings for culture for intractable infections, and if infection confirmed consider oral terbinafine/ itraconazole.
Terbinafine
- 250mg daily for 4 weeks
Itraconazole
- Tinea corporis / tinea cruis
- 100mg once daily for 15 days, or
- 200mg once daily for 7 days
- Tinea pedis / tinea manuum
- 100mg once daily for 30 days
Proximal fingernail or toenail (adults)
Take nail clippings and only start therapy if infection is confirmed by laboratory.
Oral terbinafine is more effective than oral azoles (fungicidal agent). Idiosyncratic liver reactions occur rarely with terbinafine.
Terbinafine
- 250mg daily
- Treat fingernails for 6 to 12 weeks
- Treat toenails for 3-6 months
Pulsed itraconazole monthly is recommended for infections with candida and non-dermatophyte moulds.
Itraconazole
- 200mg twice daily for 7 consecutive days repeated at 21 day intervals
- Treat fingernails with 2 courses
- Treat toenails for 3 courses
Warnings on itraconazole use
- Itraconazole has a negative inotropic effect:
- It should not be used in patients with heart failure or at risk of it
- It should not be used with other negatively inotropic drugs such as calcium channel blockers
- Itraconazole has a range of clinically important drug interactions such as statins, anti-epileptics, anti-arrhythmics, antihistamines, calcium channel blockers, HIV drugs. This list is not exhaustive and the BNF or other texts should be consulted
- Absorption of itraconazole is pH dependent. It is reduced by antacids and PPIs. Avoid antacids for 2 hours. If on a PPI, take itraconazole with an acidic drink
- Do not use itraconazole if there is a past history of hepatic disease
