STRIDE DUO™:  Two-Medication Combo

Terbinafine is an allylamine antifungal that works by specifically targeting the enzyme squalene epoxidase, which is crucial for the biosynthesis of ergosterol, an essential component of fungal cell membranes. By inhibiting this enzyme, Terbinafine causes a deficiency in ergosterol and an accumulation of squalene within the fungal cells, leading to fungal cell death. This mode of action is particularly effective against dermatophytes, the most common fungi responsible for nail infections.

Clinical studies have consistently shown high cure rates with Terbinafine, often exceeding 70-90% effectiveness, depending on the duration of treatment and severity of the infection. This high efficacy rate is a compelling reason for its primary use in treatment protocols.

Terbinafine is well-absorbed orally and has excellent tissue penetration, especially into the nails and skin, where it remains for extended periods even after the cessation of treatment. This characteristic ensures ongoing antifungal activity and reduces the total duration of therapy needed to clear the infection.

Compared to other antifungals, fungi develop resistance to Terbinafine less frequently. This lower resistance rate makes it a reliable choice for treatment, especially in areas where fungal infections are prevalent.

Fluconazole belongs to the azole class of antifungals, which are known for their broad-spectrum activity. It works by inhibiting the enzyme lanosterol 14α-demethylase, which is involved in the synthesis of ergosterol, a vital component of fungal cell membranes. This disruption leads to increased membrane permeability and eventual fungal cell death. While it is effective against a wide variety of fungi, it is particularly useful against yeast infections and certain molds, which might coexist with or mimic toenail fungus infections.

Fluconazole is often appreciated for its convenient dosing regimen. Unlike some other antifungals that require daily administration, Fluconazole can be prescribed in a once-weekly dosage, which can improve patient compliance and convenience, especially in long-term treatments necessary for clearing nail fungus.

Patients who experience or are at risk of severe side effects from Terbinafine, such as those with liver issues or who have had adverse reactions to allylamine antifungals, may find Fluconazole a safer alternative. Its different mechanism and metabolic pathway mean it often presents a different side effect profile.

In cases where fungal strains have developed resistance to other treatments, Fluconazole may still prove effective. This makes it a valuable option for treating difficult cases where first-line treatments have failed.