{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:41:05Z","timestamp":1791578465957,"version":"4.3.4"},"reference-count":37,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T00:00:00Z","timestamp":1722384000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Over the past decades, the increasing incidence of recurrent dermatophytosis associated with terbinafine\u2010resistant <jats:italic>Trichophyton<\/jats:italic> has posed a serious challenge in management of dermatophytosis. Independent reports of failure of treatment and high minimum inhibitory concentrations (MIC) of antifungals are available, but data correlating MIC and clinical outcomes is still sparse. Therefore, the present study was conducted to evaluate the outcomes of systemic treatment of dermatophytosis and its correlation with MIC of the etiological agents isolated from such patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective analysis of 587 consecutive patients with dermatophytosis was done from March 2017 to March 2019. Demographic and clinical details of the patients were noted, along with the results of direct microscopy and fungal culture. The isolates were identified by sequencing the internal transcribed spacer region of rDNA. Antifungal susceptibility testing was performed following the CLSI M38 protocol. Mutation in the squalene epoxidase (<jats:italic>SE<\/jats:italic>) gene was detected by DNA sequencing and ARMS\u2010PCR. Based on the culture\u2010positivity and prescribed systemic antifungal, patients were categorised into Group I culture\u2010positive cases treated with systemic terbinafine and Group II culture\u2010positive cases treated with systemic itraconazole, each for a total period of 12\u2009weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the present study, 477 (81.39%) were culture\u2010positive; however, 12\u2009weeks follow\u2010up was available for 294 patients (Group I\u2010157 and Group II\u2010137) who were included for statistical analysis. In both groups [Group I\u201037\/63 (51.4%) and Group II\u201014\/54 (58.3%)], a better cure rate was observed if the initiation of therapy was performed within &lt;6\u2009months of illness. Treatment outcome revealed that if therapy was extended for 8\u201312\u2009weeks, the odds of cure rate are significantly better (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) with either itraconazole (Odd Ratio\u201015.5) or terbinafine (Odd Ratio\u20104.34). Higher MICs for terbinafine were noted in 41 cases (cured\u201018 and uncured\u201023) in Group I and 39 cases (cured\u201016 and uncured\u201023) in Group II. From cured (Group I\u201017\/18; 94.4% and Group II\u201014\/16; 87.5%) and uncured (Group I\u201020\/23; 86.9% and Group II\u201021\/23; 91.3%) cases had F397L mutation in the <jats:italic>SE<\/jats:italic> gene. No significant difference in cure rate was observed in patients with <jats:italic>Trichophyton<\/jats:italic> spp. having terbinafine MIC\u2009\u2265\u20091or &lt;1\u2009\u03bcg\/mL (Group I\u2010<jats:italic>p<\/jats:italic>\u2009=\u2009.712 and Group II\u2010<jats:italic>p<\/jats:italic>\u2009=\u2009.69).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study revealed that prolonging terbinafine or itraconazole therapy for beyond 8\u2009weeks rather than the standard 4\u2009weeks significantly increases the cure rate. Moreover, no correlation has been observed between antifungal susceptibility and clinical outcomes. The MIC remains the primary parameter for defining antifungal activity and predicting the potency of antifungal agents against specific fungi. However, predicting therapeutic success based solely on the MIC of a fungal strain is not always reliable, as studies have shown a poor correlation between in\u00a0vitro data and in\u00a0vivo outcomes. To address this issue, further correlation of antifungal susceptibility testing (AFST) data with clinical outcomes and therapeutic drug monitoring is needed. It also highlights that initiation of the treatment within &lt;6\u2009months of illness increases cure rates and reduces recurrence. Extensive research is warranted to establish a better treatment regime for dermatophytosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.13778","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:30:26Z","timestamp":1722472226000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Prolonged treatment of dermatophytosis caused by <i>Trichophyton indotinea<\/i> with terbinafine or itraconazole impacts better outcomes irrespective of mutation in the squalene epoxidase gene"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0436-7726","authenticated-orcid":false,"given":"Dipika","family":"Shaw","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology Postgraduate Institute of Medical Education and Research  Chandigarh India"},{"name":"Department of Microbiology, Jawaharlal Nehru Medical College Datta Meghe Institute of Higher 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