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Revista Da Associacao Medica Brasileira... 2012To evaluate and compare the efficacy of topical antifungal drugs applied to the treatment of each dermatomycosis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate and compare the efficacy of topical antifungal drugs applied to the treatment of each dermatomycosis.
METHODS
A systematic review of randomized clinical trials, published in Portuguese, Spanish and English until July 2010, which compared the use of azole and allylamine antifungal drugs among themselves and with placebo in the treatment of cutaneous candidiasis and T. versicolor, T. pedis, T. cruris and T. corporis was performed. The efficacy outcomes evaluated were mycological cure at the end of treatment and sustained cure.
RESULTS
Of the 4,424 studies initially identified, 49 met the selection criteria and were included in the meta-analyses. The grouped efficacy data evidenced the superiority of antifungal drugs compared to placebo, regardless of the dermatomycosis under evaluation, with odds ratio values ranging from 2.05 (95% CI 1.18-3.54) to 67.53 (95% CI 11.43-398.86). Allylamines were better than azoles only for the outcome sustained cure (OR 0.52 [95% CI 0.31-0.89]).
CONCLUSION
There is consistent evidence of the superiority of antifungal drugs over the use of placebo, and placebo-controlled studies are no longer justifiable. Allylamines maintain the mycological cure for longer periods compared to azole drugs. Given the significant cost difference among the classes, pharmacoeconomic analyses should be performed.
Topics: Administration, Cutaneous; Antifungal Agents; Candidiasis, Cutaneous; Humans; Randomized Controlled Trials as Topic; Tinea; Treatment Outcome
PubMed: 22735222
DOI: No ID Found -
BMJ Clinical Evidence Aug 2011Fungal infections are reported to cause 23% of foot diseases and 50% of nail conditions in people seen by dermatologists, but are less common in the general population,... (Review)
Review
INTRODUCTION
Fungal infections are reported to cause 23% of foot diseases and 50% of nail conditions in people seen by dermatologists, but are less common in the general population, affecting 3% to 5% of people.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral treatments for fungal toenail infections? What are the effects of topical treatments for fungal toenail infections? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 12 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: amorolfine, butenafine, ciclopirox, fluconazole, griseofulvin, itraconazole, ketoconazole, mechanical debridement, terbinafine, and tioconazole.
Topics: Administration, Oral; Administration, Topical; Debridement; Humans; Itraconazole; Nails; Onychomycosis
PubMed: 21846413
DOI: No ID Found -
The Cochrane Database of Systematic... Oct 2009Sporotrichosis is a subacute or chronic disease, usually affecting the skin caused by a dimorphic (existing in two forms), aerobic (oxygen requiring) fungus called... (Review)
Review
BACKGROUND
Sporotrichosis is a subacute or chronic disease, usually affecting the skin caused by a dimorphic (existing in two forms), aerobic (oxygen requiring) fungus called Sporothrix schenckii. Oral potassium iodide is widely used for cutaneous sporotrichosis in clinical medicine with more and more reports published. However, the benefits and adverse reactions of these treatments have not yet been systematically reviewed.
OBJECTIVES
To assess the effects of oral potassium iodide for the treatment of sporotrichosis.
SEARCH STRATEGY
In July 2009 we searched the Cochrane Skin Group Specialised Skin Register, the Cochrane Central Register of Controlled Clinical Trials (CENTRAL) in The Cochrane Library (Issue 3, 2009), MEDLINE and EMBASE, The Chinese Biomedical Database, CNKI, VIP, and ongoing trials registers.
SELECTION CRITERIA
Randomised trials comparing orally administered iodide with placebo, or with another treatment. Studies about potassium iodide as an adjunct were excluded.
DATA COLLECTION AND ANALYSIS
Two authors planned to independently assess trial quality and extract data. We also planned to collect adverse effects information from the trials where possible.
MAIN RESULTS
In the absence of any suitable randomised placebo-controlled trials or comparisons with other treatments in this area, we were unable to assess the effects of oral potassium iodide.
AUTHORS' CONCLUSIONS
The currently available evidence is insufficient to assess the potential for oral potassium iodide in the treatment of sporotrichosis.There is no high-quality evidence for or against oral potassium iodide as a treatment for sporotrichosis. Further randomised double-blind placebo-controlled trials are needed to define the efficacy and acceptability of these interventions.
Topics: Administration, Oral; Antifungal Agents; Humans; Potassium Iodide; Sporotrichosis
PubMed: 19821356
DOI: 10.1002/14651858.CD006136.pub2 -
BMJ Clinical Evidence Jul 2009Around 15% to 25% of people are likely to have athlete's foot at any one time. The infection can spread to other parts of the body and to other people. (Review)
Review
INTRODUCTION
Around 15% to 25% of people are likely to have athlete's foot at any one time. The infection can spread to other parts of the body and to other people.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical treatments for athlete's foot? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 14 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: improved foot hygiene, including socks and hosiery; topical allylamines (naftifine and terbinafine); topical azoles (bifonazole, clotrimazole, econazole nitrate, miconazole nitrate, sulconazole nitrate, and tioconazole); and topical ciclopirox olamine.
Topics: Administration, Oral; Administration, Topical; Clotrimazole; Drug Administration Schedule; Econazole; Evidence-Based Medicine; Humans; Hygiene; Miconazole; Tinea Pedis
PubMed: 21696646
DOI: No ID Found -
BMJ Clinical Evidence Dec 2008Fungal infections are reported to cause 23% of foot diseases and 50% of nail conditions in people seen by dermatologists, but are less common in the general population,... (Review)
Review
INTRODUCTION
Fungal infections are reported to cause 23% of foot diseases and 50% of nail conditions in people seen by dermatologists, but are less common in the general population, affecting 3-5% of people.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral treatments for fungal toenail infections? What are the effects of topical treatments for fungal toenail infections? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 11 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: amorolfine, butenafine, ciclopirox, fluconazole, griseofulvin, itraconazole, ketoconazole, mechanical debridement, terbinafine, and tioconazole.
Topics: Administration, Oral; Administration, Topical; Debridement; Foot Diseases; Humans; Itraconazole; Nails; Onychomycosis
PubMed: 19445781
DOI: No ID Found -
The Cochrane Database of Systematic... Jul 2007Fungal infections of the feet normally occur in the outermost layer of the skin (epidermis). The skin between the toes is a frequent site of infection which can cause... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fungal infections of the feet normally occur in the outermost layer of the skin (epidermis). The skin between the toes is a frequent site of infection which can cause pain and itchiness. Fungal infections of the nail (onychomycosis) can affect the entire nail plate.
OBJECTIVES
To assess the effects of topical treatments in successfully treating (rate of treatment failure) fungal infections of the skin of the feet and toenails and in preventing recurrence.
SEARCH STRATEGY
We searched the Cochrane Skin Group Specialised Register (January 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE and EMBASE (from inception to January 2005). We screened the Science Citation Index, BIOSIS, CAB - Health and Healthstar, CINAHL DARE, NHS Economic Evaluation Database and EconLit (March 2005). Bibliographies were searched.
SELECTION CRITERIA
Randomised controlled trials (RCTs) using participants who had mycologically diagnosed fungal infections of the skin and nails of the foot.
DATA COLLECTION AND ANALYSIS
Two authors independently summarised the included trials and appraised their quality of reporting using a structured data extraction tool.
MAIN RESULTS
Of the 144 identified papers, 67 trials met the inclusion criteria. Placebo-controlled trials yielded the following pooled risk ratios (RR) of treatment failure for skin infections: allylamines RR 0.33 (95% CI 0.24 to 0.44); azoles RR 0.30 (95% CI 0.20 to 0.45); ciclopiroxolamine RR 0.27 (95% CI 0.11 to 0.66); tolnaftate RR 0.19 (95% CI 0.08 to 0.44); butenafine RR 0.33 (95% CI 0.24 to 0.45); undecanoates RR 0.29 (95% CI 0.12 - 0.70). Meta-analysis of 11 trials comparing allylamines and azoles showed a risk ratio of treatment failure RR 0.63 (95% CI 0.42 to 0.94) in favour of allylamines. Evidence for the management of topical treatments for infections of the toenails is sparser. There is some evidence that ciclopiroxolamine and butenafine are both effective but they both need to be applied daily for prolonged periods (at least 1 year). The 6 trials of nail infections provided evidence that topical ciclopiroxolamine has poor cure rates and that amorolfine might be substantially more effective but more research is required.
AUTHORS' CONCLUSIONS
Placebo-controlled trials of allylamines and azoles for athlete's foot consistently produce much higher percentages of cure than placebo. Allylamines cure slightly more infections than azoles and are now available OTC. Further research into the effectiveness of antifungal agents for nail infections is required.
Topics: Administration, Topical; Antifungal Agents; Dermatomycoses; Female; Foot Dermatoses; Humans; Male; Onychomycosis; Randomized Controlled Trials as Topic
PubMed: 17636672
DOI: 10.1002/14651858.CD001434.pub2 -
BMJ (Clinical Research Ed.) Jul 1999To identify and synthesise the evidence for efficacy and cost effectiveness of topical treatments for superficial fungal infections of the skin and nails of the feet. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To identify and synthesise the evidence for efficacy and cost effectiveness of topical treatments for superficial fungal infections of the skin and nails of the feet.
DESIGN
Systematic review.
INTERVENTIONS
Topical treatments for superficial fungal infections.
MAIN OUTCOME MEASURES
Cure confirmed by culture and microscopy for skin and by culture for nails in patients with clinically diagnosed fungal infections.
RESULTS
Of 126 trials identified in 121 papers, 72 (57.1%) met the inclusion criteria. Placebo controlled trials yielded pooled relative risks of failure to cure skin infections: allylamines (0.30, 95% confidence interval 0.24 to 0.38); azoles (0.54, 0.42 to 0.68); undecenoic acid (0.28, 0. 11 to 0.74); and tolnaftate (0.46, 0.17 to 1.22). Although meta-analysis of 11 trials comparing allylamines and azoles showed a relative risk of failure to cure of 0.88 (0.78 to 0.99) in favour of allylamines, there was evidence of language bias. Seven reports in English favoured allylamines (0.79, 0.69 to 0.91), but four reports in foreign languages showed no difference between the two drugs (1. 01, 0.90 to 1.13). Neither trial of nail infections showed significant differences between alternative topical treatments.
CONCLUSIONS
Allylamines, azoles, and undecenoic acid were efficacious in placebo controlled trials. There are sufficient comparative trials to judge relative efficacy only between allylamines and azoles. Allylamines cure slightly more infections than azoles but are much more expensive than azoles. The most cost effective strategy is first to treat with azoles or undecenoic acid and to use allylamines only if that fails.
Topics: Administration, Topical; Allylamine; Antifungal Agents; Azoles; Cost-Benefit Analysis; Dermatomycoses; Foot Dermatoses; Humans; Nonprescription Drugs; Onychomycosis; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 10398626
DOI: 10.1136/bmj.319.7202.79