Choosing an antifungal drug

Aug 10, 2003 (Updated Sep 15, 2003)

The Bottom Line Choose a fungicidal drug for fastest cure. Use fungistatic drugs as a backup.

My condition:

The skin was peeling between my little toes for months. I finally decided to do something.

My treatment:

I used Lotrimin AF daily for about 2 weeks, and saw my condition gradually improve (less peeling). Then on the recommendation of a doctor, I switched to Lotrimin Ultra, and my symptoms disappeared in five days. Lotrimin AF didn't quite do the trick, but Lotrimin Ultra did.

As per instructions, I continued daily treatment for two weeks after the symptoms disappeared, to completely kill off any lingering fungal cells that might grow back.

What I learned:

Over-the-counter antifungal medications fall into two categories, fungistatic and fungicidal. The azole chemistry of fungistatic medications prevents the growth of new fungal cells. The allylamine chemistry of fungicidal medications brings death to existing fungal cells. Fungicidal drugs are supposed to cure faster than fungistatic drugs.

Commonly available antifungal drugs:

Tolnaftate: Tinactin, generics. Available without a prescription since the 1960's. Inexpensive and generally least effective. Cost: $2-$7 for 12g-24g tube.

Miconazole: Micatin, Monistat, generics. Fungistatic. Effective against candida (yeasts). Available without a prescription since 1990ish.

Clotrimazole: Lotrimin AF, generics. Fungistatic. Available without a prescription since 1991. Cost: $6-$9 for 24g tube.

Ketoconazole: Prescription drug in the USA. Available without a scrip in Canada. Often taken orally to fight toenail fungus, or blended into shampoo.

Terbinafine: LamisilAT. Fungicidal. Available without a prescription since 1999. Cost: $12 for 24g tube.

Butenafine: Lotrimin Ultra. Fungicidal. Available without a prescription since 1997 in Canada, 2001 in USA. Proven effective against some candida strains. Cost: $11 for 24g tube.

Comparing Lotrimin's drugs, both Clotrimazole and Butenafine exhibit broad spectrum activity -- they kill 80%-100% of fungal infections. The major clinical difference is that Butenafine works faster, bringing relief in days and total cure in two weeks instead of four weeks, so it's a logical choice as a first line of defense.

Depending on your particular infection, one drug may be more effective than another. If Butenafine fails to cure an infection, a person can later switch to Clotrimazole, or vice versa. Some fungal strains respond to some drugs but not others.


Use the newer meds. The only reason to use older Lotrimin, Tinactin, or Micatin products is a tight budget because Lotrimin Ultra / LamisilAT contain more effective drugs. But even then, you can buy a generic version for half the cost of name brand.

Do cocktails, using both Lotrimin AF and Lotrimin Ultra simultaneously. Use one in the morning, and the other at night. Since each drug attacks a different part of the fungal cell, a cocktail of two drugs may be more potent than using only one drug. This also helps defeat an infection that turns out to be resistant to a particular drug.

Finally, give some thought to your blood sugar. Persistent athlete's foot is a good indicator that your blood sugar is too high. Test yourself for diabetes. At the very least think about your sugar intake -- long-term elevated blood sugar, like untreated diabetes, does permanent damage to your body.

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