Terbinafine is an effective systemic treatment for onychomycosis, a fungal infection of the nail. Pediatric cases of the infection, which results in discoloration and thickening of the nails, usually respond well to topical treatments, but when the infection starts to affect the nail’s matrix, a systemic option is needed. When adults use terbinafine, they undergo routine lab monitoring due to some possible hepatotoxic effects.
A recent study sought to determine whether providers utilize laboratory monitoring during therapy in children and the prevalence of laboratory abnormalities during systemic terbinafine therapy in pediatric patients.
More than 250 children treated with terbinafine for onychomycosis over an 8-year period were included in the retrospective study. About 70% of the patients were treated by their pediatrician, and about 30% by a pediatric dermatologist. A total of 144 (53.5%) patients underwent laboratory monitoring of liver function panels and/or complete blood cell counts. Very few patients (less than 15%) developed a laboratory abnormality, and none were beyond a grade 1 laboratory abnormality.
Based on these data, the authors recommend that children receive baseline transaminase monitoring. They state that routine laboratory monitoring during therapy in healthy children may be unnecessary.