In Vitro Susceptibility of Dermatophytes to Terbinafine and Itraconazole: MIC Distributions and Elevated-MIC Isolates in Faisalabad, Pakistan

Dermatophyte infections of the skin, hair and nails are common in Pakistan, and treatment failure with standard antifungal drugs is increasingly reported. Local laboratory data on how dermatophytes respond to terbinafine and itraconazole are limited. This study will collect skin scrapings, hair or nail samples from consecutive dermatology outpatients with KOH-confirmed dermatophytosis, grow the fungi in culture, and test each isolate against terbinafine and itraconazole using the standard CLSI M38 broth microdilution method. The study will report the proportion of Trichophyton isolates with an elevated terbinafine minimum inhibitory concentration (MIC), the MIC distributions of both drugs, and the species involved, and will explore whether elevated terbinafine MICs are associated with clinical features such as disease duration, previous antifungal use and topical corticosteroid use. Participation does not change treatment; the study only tests samples in the laboratory.

Inclusion Criteria: * Clinically suspected dermatophytosis confirmed by KOH microscopy * Male and female patients of all age groups * Informed consent from the patient, or from a parent/guardian with child assent for those under 18 years Exclusion Criteria: * Current systemic antifungal therapy, or topical or systemic antifungal use within the previous 2 weeks * Immunocompromised patients * Pregnant or lactating women * Unwilling to participate