In vitro activity of terbinafine (Lamisil®):: An update

Terbinafine (Lamisil(R)) is active in vitro against a broad spectrum of pathogenic fungi. Against dermatophytes, it is the most potent of available antimycotics, and MICs are in the ng/ml range for most isolates, in keeping with the high clinical efficacy against dermatophytoses. Terbinafine is also active against many other filamentous, dematiaceous and dimorphic fungi, with MICs often well below 1 mu g/ml, and a primary fungicidal action. In earlier in vitro studies, the activity against yeasts was very variable depending on the test system used, but recent work with the standardized NCCLS assay has shown mean MICs of 1-2 mu g/ml against Candida albicans and of 0.08 mu g/ml against C. parapsilosis. Terbinafine is also active against Cryptococcus species (MICs 0.06-2 mu g/ml), and some other yeasts causing skin infections, such as Malassezia and Trichosporon beigelii. Recent work has demonstrated in vitro synergy between terbinafine and azoles against several pathogens, including multidrug-resistant Candida isolates resistant to both drugs when used singly. We conclude that, in addition to its current clinical applications against superficial mycoses, terbinafine may also find use in therapy of various subcutaneous and deep mycoses.