Implications for practice

All antifungal creams, whether over the counter or those available in supermarkets are effective in the treatment of athlete's foot.

Prescription-only antifungal creams produce slightly higher cure rates than all other creams. The available evidence indicates that the most cost-effective management strategy for athlete's foot is an over-the-counter cream twice daily for 4 weeks, with prescription only cream reserved for treatment failures.14

What are the most effective oral drugs in the treatment of athlete's foot?

There appears to be no therapeutic advantage in using an allylamine cream (terbinafine or naftifine) for 1 week rather than an azole cream for 4 weeks. The hypothesis that higher compliance rates are likely to be associated with shorter treatment times is often quoted but has not been tested.15

If no advantage is gained from treating interdigital athlete's foot with oral antifungals, physicians should be cautious in prescribing oral drugs to manage moccasin type (infection over the sole of the foot). The belief that recalcitrant cases of athlete's foot are more effectively managed with oral drugs has not been extensively tested.

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