The Compliance of Oral Antifungal Therapy in the Patients with Toenail Onychomycosis in Daegu Area: Comparison between Terbinafine Continuous Therapy and Itraconazole Pulse Therapy

Kim, Ki Hong; Jeong, Ki Baek; Choi, Jong Soo; Kim, Do Won; Jun, Jae Bok; Song, Joon Young

Abstract

BACKGROUND: The treatment of toenail onychomycosis requires a long term oral medication of antifungal agent, and its compliance is one of the important factors for the treatment of toenail onychomycosis.
OBJECTIVE
The purpose of this study was to evaluate compliance of terbinafine continuous therapy group (C group) and itraconazole pulse therapy group (P group), and to analyze the causes of stopping the treatment.
METHODS
The medical records of 387 patients (C group: 177, P group: 210) with toenail onychomycosis were analyzed. The cause to stop the treatment was investigated among the drop-out patients by selfassessment questionnaires or phone calls.
RESULTS
One hundred and fifty eight patients (40.8%) of the 387 patients with toenail onychomycosis completed their treatment courses, and compliance was higher in university hospital group (59.5%) than in private clinic group (20.9%). The compliance of P group (50.9%) was significantly higher than that of C group (28.8%, p<0.05). As to age group, compliance was relatively low at age group of the fourth and fifth decade in total patients and C group, and at age group of the third, fourth and fifth decade in P group. There were no significant differences between male and female patients in P group, but the compliance of the male patients (34.7%) was higher than that of female patients (21.5%) in C group. The compliance of the patients who had toenail onychomycosis for a year and more than one year (58.3%) was higher than that of patients for less than one year duration (37.5%). One hundred and seventy nine patients out of the 229 patients (C group: 101, P group: 78) who stopped the treatment, responded to self-assessment questionnaire or phone calls. Among 101 patients who responded in C group, 64 patients (63.4%) stopped the treatment within 1 month, 32 patients (31.7%) within 2 months. Among 78 patients who responded in P group, 68 patients (87.2%) stopped the treatment within 1 month, and 10 patients (12.8%) within 2 months. The causes of stopping the treatment were "lack of time to visit clinic" (29.4%), good response (24.9%), far a long distance to the clinic (18.1%), etc., in order.
CONCLUSION
For the better choice of therapy, dermatologist must consider age, sex, and disease duration, select the treatment method, and explain the course of treatment to the patients. So do that, we can increase the compliance of patients with toenail onychomycosis.