Emerging Terbinafine Resistant Trichophyton Dermatophytosis, Testing Options and Alternative Treatments: A Systematic Review
Abstract
Dermatophytosis is a common superficial fungal infection of the skin, most often caused by dermatophytes from the Trichophyton genus. Terbinafine, which inhibits squalene epoxidase (SQLE), is widely used as first line treatment. However, resistance to terbinafine is increasing globally, including recent reports in Australia, with origins suspected to trace back to South Asia. Antifungal susceptibility testing is not routinely available in Australia, and globally, there are no standardised breakpoints for traditional culture-based methods. Although SQLE gene mutations have been associated with terbinafine resistance, a major research gap exists in the clinical interpretation of these mutations due to a lack of correlation between MIC values, genetic mutations and clinical treatment outcomes. This gap hampers the ability to guide clinical decision-making. Therefore, our objective was to assess the global prevalence of terbinafine-resistant Trichophyton infections, identify the most clinically relevant resistance testing methods, and determine effective alternative treatment options. The study was designed by systematic review. Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews (CDSR), Cochrane's Trials database (CENTRAL), Global Health (CABI), Trials registries, along with Google Scholar and Web of Science (WoS) for the tracking of included articles. Published human studies in English from 2000 to 2023 of Terbinafine-resistant Trichophyton Dermatophytosis with…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 149 participants or records.
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