Fenticonazole is an
imidazole derivative with a broad spectrum of antimycotic activity against dermatophytes and yeasts in in vitro and clinical studies.
Fenticonazole exerts its unique antimycotic mechanism of action in the following three ways: (i) inhibition of the secretion of
protease acid by Candida albicans; (ii) damage to the cytoplasmic membrane; and (iii) by blocking
cytochrome oxidases and peroxidises.
Fenticonazole has also been shown to exhibit antibacterial action, with a spectrum of activity that includes bacteria commonly associated with superinfected fungal skin and vaginal
infections, and
antiparasitic action against the protozoan Trichomonas vaginalis. Therefore,
fenticonazole may be an ideal topical alternative to multi-agent treatment of
mixed infections involving mycotic, bacterial, dermatophyte and/or Trichomonas spp.Open-label clinical studies show that
fenticonazole, in different pharmaceutical preparations administered once or twice daily, is effective in the treatment of superficial
mycoses of the skin. In particular,
fenticonazole is very effective (often with 100% of patients achieving a negative mycological assay) in
pityriasis versicolor and
candidiasis. For example, a large (n = 760) study showed
fenticonazole 2% cream, spray or
powder to be associated with a mycological response in 100% of patients with
pityriasis versicolor, 96.3% of those with
tinea infections and 95.2% of patients with
Candida infections. Comparative clinical studies show
fenticonazole once or twice daily to be at least as effective as six different topical antimycotics (
miconazole,
clotrimazole,
econazole,
bifonazole,
naftifine and
cyclopyroxolamine) in the treatment of superficial
mycoses of the skin.
Intravaginal administration of
fenticonazole is associated with a high rate of microbiological efficacy in patients with vaginal
candidiasis,
trichomoniasis,
mixed infection and
bacterial vaginosis. Intravaginal
fenticonazole is at least as effective as
clotrimazole and shows similar efficacy to
miconazole in patients with vaginal
candidiasis.
Fenticonazole has a rapid onset of action and clinical efficacy is generally observed within days of commencing treatment.Topical
fenticonazole is very well tolerated; adverse events are generally mild to moderate in severity and transient. The most frequent adverse events are burning sensation/cutaneous irritation and itch when applied to the skin. In a large, open-label study in superficial
mycoses of the skin, the incidence of adverse events was <5% and these were rarely responsible for treatment discontinuation. Burning sensation is the most common adverse event seen with
fenticonazole when administered intravaginally. However, this symptom of vaginal
fungal infection was often present in patients prior to
drug administration.Given the rising incidence of superficial fungal, and possibly
mixed, infections, topical
fenticonazole represents an important part of the topical antimycotic armamentarium.