Topical therapy is effective for tinea pedis. Topical terbinafine has a 70% cure rate, is available over the counter (OTC), and requires only 1 to 2 weeks of therapy. Two other OTC topicals, tolnaftate and miconazole, require 2 to 4 weeks to achieve slightly lower cure rates, but are considerably less expensive. (Grade of recommendation: A) The most effective treatment for tinea pedis is oral terbinafine 250 mg twice a day for 2 weeks (94% clinical cure rate). However, oral terbinafine is expensive and not approved for this indication. Oral therapy may be required for patients with hyperkerototic soles, severe disease, topical therapy failure, chronic infection or immunosuppression. (Grade of recommendation: B, based on small randomized controlled trials [RCTs] with limited head-to head comparisons of drugs
