Efficacy of Lotrimin?

[alwaystired]

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Patient has fungal infection (confirmed by MD) that covers large portion of trunk/abdomen/back and some of legs. (I guess they had this only on the legs, but let it go for a couple years and now it has spread) Dr. prescribed Lotrimin (OTC), but the patient has complaints about putting it on such a large part of their body twice a day. Dr. said they would need to do this for 6 weeks. Also, besides hepatic disease, why not Lamisil? Is Lamisil only for nail fungus? Of course, the patient wants antibiotic or some kind of pill, since BID lotrimin baths aren't appealing and he didn't seem to trust his doctor. Should he get a second opinion? I was wondering, will the ointment actually kill the fungus if they follow the directions?

 

[sdn1977]

Patient has fungal infection (confirmed by MD) that covers large portion of trunk/abdomen/back and some of legs. (I guess they had this only on the legs, but let it go for a couple years and now it has spread) Dr. prescribed Lotrimin (OTC), but the patient has complaints about putting it on such a large part of their body twice a day. Dr. said they would need to do this for 6 weeks. Also, besides hepatic disease, why not Lamisil? Is Lamisil only for nail fungus? Of course, the patient wants antibiotic or some kind of pill, since BID lotrimin baths aren't appealing and he didn't seem to trust his doctor. Should he get a second opinion? I was wondering, will the ointment actually kill the fungus if they follow the directions?

Yeah...I'd balk too, but at the 6 weeks the therapy. I wouldn't necessarily say no this is wrong, however, this is unusual for long term therapy for this large of a body area. I'd be interested to know if the MD did a scraping & identified the fungus because for some it is fungicidal & for others only fungistatic.

No..Lamisil (I assume you mean tablets?) is not just for nail fungus. It has a wide spectrum of antifungal activity, but requires a long duration of therapy & often not covered by insurance without prior auth (its expensive to dispense & requires lab work). Often, the course of tx is otcs, if no improvement - combination of topical rx's, if no improvement - oral w/ topical.

What would I do? Ask if your pt saw his PCP or did he see a dermatologist? However, I would encourage him to begin tx as prescribed reassuring him often fungal infections require 4 wks or more of tx. If he is not improving, he might return to his MD or pursue a consultation with a dermatologist.

 

[alwaystired]

Yeah...I'd balk too, but at the 6 weeks the therapy. I wouldn't necessarily say no this is wrong, however, this is unusual for long term therapy for this large of a body area. I'd be interested to know if the MD did a scraping & identified the fungus because for some it is fungicidal & for others only fungistatic.

No..Lamisil (I assume you mean tablets?) is not just for nail fungus. It has a wide spectrum of antifungal activity, but requires a long duration of therapy & often not covered by insurance without prior auth (its expensive to dispense & requires lab work). Often, the course of tx is otcs, if no improvement - combination of topical rx's, if no improvement - oral w/ topical.

What would I do? Ask if your pt saw his PCP or did he see a dermatologist? However, I would encourage him to begin tx as prescribed reassuring him often fungal infections require 4 wks or more of tx. If he is not improving, he might return to his MD or pursue a consultation with a dermatologist.

That's a good idea about the dermatologist, I assume he saw PCP. I looked at some articles online about skin fungi and they said that it is sometimes hard to determine what specific fungus, or if there are multiple, etc. A dermatologist would probably be better. I am surprised they didn't send him to one since it was such a sizable area.

 

[All4MyDaughter]

Lamisil is about $450 for a one-month supply, at least where I work.
It requires a PA on a lot of insurance plans.

 

[usi]

And lamisil has that gross commercial about dermatophites

 

[ultracet]

And lamisil has that gross commercial about dermatophites

hey now...
digger is the man!!

 

[bananaface]

Lamisil isn't the first oral antifungal that comes to mind. Fluconazole is cheaper and more widely used. Perhaps this patient is on some other medication and the physician is worried about a drug interaction. But, with twice daily large scale application, there would probably be systemic absorbtion of Lamisil too. The physician may also want to give the patient a treatment that can be used in case of recurrance, reducing the need for future office visits. I'd be worried that it would be impossible for even the most enthusiastic patient to reach every bit of the fungus affected area twice a day for 6 weeks, since it sounds like such a large area. Your concerns sound legitimate. No matter what treatment is used, the patient needs to be sure to bathe/shower regularly and dry off completely afterwards.

 

[sdn1977]

Actually, fluconazole was not the oral antifungal which would be first in my mind because of the microbiology. Fluconazole is great against Cryptococcus neoformans & Candida sp. (the anticandidal is why it is often used for fungal infections of the milk ducts in nursing mothers), but it is more fungistatic for Epidermophyton & Trichophyton sp. Most tineas are caused by one of these last two sp. I've seen fluconazole used for topical infections on the body, but therapy is as long as terbinafine, its as difficult to obtain PA & long term tx requires monitoring renal function since dose is reduced by half with decreased clearance.

I'd add....a common addition to topical antifungal tx is a daily body wash w/ selenium sulfide shampoo. It is common for tinea versicolor & probably for most other tineas. The directions are not "shampoo"...but "apply to affected areas, lather & allow to remain on skin for 10 minutes, then rinse" if the pt questions when they receive a shampoo & are told by their Dr to use on the whole body.

 

[usi]

hey now...
digger is the man!!

Digger gives me the creeps! (Uttered as I scratch my head and chest)