Wirksamkeit der Itraconazol-Intervalltherapie bei Onychomykose

The efficacy and tolerability of itraconazole pulse therapy (3 one-week pulses with itraconazole 400 (2 x 200) mg daily every month) were investigated in 623 patients with toenail mycoses in an open multicentre study in Germany. An additional fingernail involvement was present in 63 patients. Approximately 11% had isolated yeast and mould infections, and 5% had mixed infections. Itraconazole (200 mg twice daily) was given for one week each month for a period of 3 months. An additional one-week course was allowed after 6 weeks if the patient was either not cured or there was no marked improvement. At the end of the 13-week follow-up period, 7.5 months after start of treatment, 75% of the patients suffering from onychomycosis of the toes and 92.7% of those with fingernail mycoses showed mycological cure (negative microscopy and negative culture). The clinical response rate (cured or markedly improved) was about 90% in both groups. The broad action spectrum of itraconazole enabled effective treatment irrespective of the pathogenic fungus. Treatment was discontinued in only 22 cases (3.5%) because of adverse side effects which however, were all light and reversible. The low number of study discontinuations - only 57 of 623 patients - indicates the high acceptability of this treatment.