口服抗真菌药物治疗足癣的系统评价

The System Review of Oral Treatments for Tinea Pedis

目的评价口服药物治疗足癣的临床疗效和费用,为足癣治疗中口服抗真菌药物的合理选择提供参考依据。方法收集国内外已公开发表的有关口服抗真菌药物治疗足癣的临床随机对照试验,对符合要求的研究进行Meta分析。结果12项研究符合本文入选标准,总病例数700。特比奈芬和伊曲康唑的治疗效果都较满意,特比奈芬(250mg/d治疗2周)和伊曲康唑(100mg/d治疗2周或4周)的临床疗效差异无统计学意义。唑类药物的疗效相似。灰黄霉素和酮康唑的治愈率无差异。特比奈芬比灰黄霉素疗效更好。结论特比奈芬和伊曲康唑的疗效都优于安慰剂。与灰黄霉素相比,特比奈芬起效快、疗效高,但费用高。

Objective To assess the effects and costs of oral treatments for fungal infections of the skin of the foot （tinea pedis）. Methods Randomised controlled trials were identified from MEDLINE, EMBASE, CINAHL and CNKI from the beginning of these databases to Mareh 2006. Randomised controlled trials including participants who have a clinically diagnosed tinea pedis, confirmed by microscopy and growth of dermatophytes in culture were selected. Results Twelve trials, involving 700 participants, were included. Two trials showed that Terbinafine and Itraconazole were effective compared with placebo. No significant difference was detected between Terbinafine and Itraconazole; Fluconazole and either Itraconazole and Ketoconazole; or between Griseofulvin and Ketoconazole, although the trials were generally small. The two trials comparing Terbinafine and Griseofulvin produced a pooled difference in favour of Terbinafine＇s ability to cure infection. Adverse effects were reported for all drugs, with Gastrointestinal effects most commonly reported. Conclusions The evidence suggests that oral antifungal durgs are effective against rinea pedis, that Terbinafine is more effective than Griseofulvin and that Terbinafine and Itraconazole are more effective than no treatment, and that they cause stomach upsets and can be quite expensive.