Imidazoles and terbinafine (an allylamine derivative) are widely accepted as being the most effective treatments for athlete’s foot.^1,2 Little difference in efficacy has been found between topical terbinafine and imidazoles, although terbinafine may clear up infections up more quickly.

Imidazoles licensed for treatment of athlete’s foot without prescription are: bifonazole, clotrimazole, econazole, ketoconazole and miconazole. They are considered to have similar efficacy.¹ These compounds also possess activity against Gram-positive bacteria, which is useful because secondary bacterial infection may complicate the fungal infection. They are available as creams, sprays and powders. Frequency of application and method of use varies with product, but treatment for at least a week after lesions have healed is generally recommended.

Terbinafine as cream, gel or spray is used once daily for a week. There is also a single-application cutaneous solution that, according to the manufacturer, forms a clear film that releases active ingredient into the skin for up to 13 days and needs only to be applied once. Local irritation and sensitivity are possible with all compounds.