Gupta AK, Kohli Y. Br J Dermatol 2003 Aug; 149(2):296-305.
The authors set out to determine the in vitro susceptibility of fungal organisms to ciclopirox, terbinafine, ketoconazole, and itraconazole, and to evaluate the in vitro activity and mode of interaction of ciclopirox in combination with either terbinafine or itraconazole. 133 strains were evaluated, including dermatophytes, Candida spp., and nondermatophyte molds. Some of the test medications had either additive, synergistic, or indifferent effects, but there were no cases of antagonism. The testing indicates that ciclopirox may have a broad antimicrobial profile including dermatophytes, yeasts, and other nondermatophytes. Terbinafine is extremely potent against dermatophytes. In vitro evaluation of activity of eiclopirox and terbinafine suggests many instances of synergy or additivism; for ciclopirox and itraconazole there may be indifference, synergy, or additivism.
JDD ARTICLE EVALUATION
In-vitro studies are a good start for any study, but once you see these organisms in-vivo you confront many complicating factors, such as competing bacteria, fungi, and environments. It would have been a more clinically relevant study if cultures of suspected patients (in-vivo) were performed and double-blinded studies involving the above medications were done. Some additive or synergistic effects are seen which can permit a lower dose of each of the medications; again, further studies are requires to recommend any therapies.
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