ABPI Medicines Compendium. Lamisil AT 1% cream. 2009. Datapharm Communications Ltd. http://www.medicines.org.uk/EMC/searchresults.aspx?term=Lamisil&searchtype=QuickSearch Accessed 23.09.14. RATIONALE: Terbinafine cream is not licensed for the treatment of Candida infection.

Public Health England Fungal skin and nail infections: diagnosis & laboratory investigation. Quick reference guide for primary care for consultation and local adaptation. 2009 https://www.gov.uk/government/publications/fungal-skin-and-nail-infections-diagnosis-and-laboratory-investigation Accessed 22.09.14. RATIONALE: The recommendation to send skin scrapings to confirm the diagnosis before starting oral treatment is based on expert opinion and clinical experience.

Bell-Syer SEM, Hart R, Crawford F, Torgerson DJ, Tyrrell W, Russel I. Oral treatments for fungal infection of the foot. Cochrane Database of Systematic Reviews. 2002. Issue 2 www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003584/frame.html Accessed 23.09.14. RATIONALE: Terbinafine: one RCT (n = 41) found that oral terbinafine, 250 mg a day for 6 weeks, was more effective than placebo for treating athlete’s foot. At 8 weeks, 65% of the terbinafine group were cured, compared with none of the placebo group (relative risk [RR] of cure with terbinafine 25, 95% CI 2 to 384). Itraconazole: one RCT (n = 77) found that oral itraconazole, 400 mg a day for 1 week, was more effective than placebo. At 9 weeks, 55% of the itraconazole group were cured compared with 8% of the placebo group (RR of cure with itraconazole 7, 95% CI 2 to 20). Terbinafine vs itraconazole: Pooled data from three RCTs (n = 222) found no difference in cure rates between oral terbinafine 250 mg a day for 2 weeks (76% cured), and itraconazole 100 mg a day for 4 weeks (71% cured); risk difference 5%, 95% CI –6 to +27

Crawford F and Hollis S. Topical treatments for fungal infections of the skin and nails of the foot. Cochrane Database of Systematic Reviews 2007. Issue 3. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001434/frame.html Accessed 23.09.14. RATIONALE: Terbinafine and imidazoles: pooled data (8 RCTs; n = 962) found little difference between allylamines (e.g. terbinafine for 1-2 weeks) and imidazoles (for 4-6 weeks) at 2 weeks after baseline. But at 6 weeks after baseline, there was a relative reduction in treatment failure with allylamines compared with imidazoles (RR 0.63, 95% CI 0.42 to 0.94). Treatment with an imidazole for 4-6weeks reduced the risk of treatment failure by 60% compared with placebo at 6-weeks (Risk Ratio 0.40, 95% CI 0.35 to 0.46; n = 1235). Treatment with an allylamine for 1-4 weeks reduced the risk of treatment failure by 67% compared with placebo at 6 weeks (Risk Ratio 0.33, 95% CI 0.24 to 0.44; n = 1116) Undecanoates: this systematic review identified two RCTs of undecanoates compared with placebo (n = 283). There was a 71% relative reduction in the risk of treatment failure at 6 weeks with 4 weeks treatment with undecanoates compared with placebo (Risk Ratio 0.29, 95% CI 0.12 to 0.70).

Gupta AK, Cooper EA. Update in antifungal therapy of dermatophytosis. Mycopathologia. 2008 Nov-Dec;166(5-6): 353-67. RATIONALE: Topical medications applied once or twice daily are the primary treatment indicated for tinea corporis/cruris, and tinea pedis/manuum. Use of oral antifungals may be practical where the tinea involvement is extensive or chronic, or where application of a topical is not feasible. For tinea unguium (onychomycosis) and tinea capitis, oral therapies are the primary treatments recommended. Topical amorolfine and ciclopirox formulations have been approved for use in milder onychomycosis cases, and their role in the treatment of the different clinical forms of onychomycosis is currently being defined. Relapse of infection remains a problem, particularly with tinea pedis/unguium. Appropriate follow-up duration and education of patients on proper foot hygiene are also important components in providing effective therapy.

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).