Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Canada.
J Dermatolog Treat. 2013 Feb;24(1):75-80. doi: 10.3109/09546634.2012.703308. Epub 2012 Jul 25.
Fluconazole could be an alternative to terbinafine and itraconazole for onychomycosis treatment. However, it is difficult to determine the optimal dosing regimen due to the variability in causative agents, dosing regimens and cure rates in clinical trials. By restricting the data to dermatophyte onychomycosis, we aimed to identify an optimal fluconazole dosing regimen.
We searched the PubMed, EMBASE and CENTRAL databases and the reference sections of published literature for clinical trials on fluconazole monotherapy for culture-proven dermatophyte onychomycosis. Relationships between fluconazole doses, cure rates and duration of therapy were analyzed.
Longer treatments, but not higher weekly fluconazole doses, resulted in better cure rates for toenail, and possibly fingernail, onychomycosis. Consequently, mean mycological and clinical cure rates for treatments lasting 6 months or less and more than 6 months were significantly different for toenail onychomycosis. Clinical studies including participants with nondermatophyte mold, Candida species, or negative culture onychomycosis only used fluconazole therapy for 6 months or less. Thus, the relationship between cure rates and duration of treatment could not be confirmed for all causative agents.
The lowest dose of 150 mg weekly for more than 6 months is recommended for onychomycosis.
氟康唑可作为特比萘芬和伊曲康唑治疗甲真菌病的替代药物。然而，由于临床试验中致病因素、剂量方案和治愈率的差异，很难确定最佳剂量方案。通过将数据限制在皮肤真菌性甲真菌病，我们旨在确定氟康唑的最佳剂量方案。
我们检索了 PubMed、EMBASE 和 CENTRAL 数据库以及已发表文献的参考文献部分，以寻找关于氟康唑单一疗法治疗经培养证实的皮肤真菌性甲真菌病的临床试验。分析了氟康唑剂量、治愈率和治疗持续时间之间的关系。
更长的治疗时间，但不是更高的每周氟康唑剂量，导致甲真菌病的治愈率更高，无论是趾甲还是手指甲。因此，对于持续 6 个月或更短时间和超过 6 个月的治疗，趾甲甲真菌病的平均真菌学和临床治愈率有显著差异。包括非皮肤真菌、念珠菌或阴性培养的甲真菌病患者仅接受 6 个月或更短时间的氟康唑治疗的临床研究。因此，不能确认所有致病因素的治愈率与治疗持续时间之间的关系。
建议对于甲真菌病，每周最低剂量 150mg 超过 6 个月。
