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Letters

Athlete's foot and fungally infected toenails

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7297.1306/a (Published 26 May 2001) Cite this as: BMJ 2001;322:1306

Authors should use familiar drug names

  1. Arabella Melville (Arabella_Melville{at}port35.freeserve.co.uk), freelance consultant and writer
  1. Porthmadog, Gwynedd LL49 9AN
  2. Department of Health Sciences and Clinical Evaluation, University of York, York YO10 5DD
  3. Podiatry Department, University of Wales Institute, Cardiff CF1 3NS
  4. Clinical Evidence, BMJ Publishing Group, London WC1H 9JR

    EDITOR—The review of effectiveness of treatments for athlete's foot seemed perfectly timed1: my shopping list for that Saturday morning included a fungicide to control the infection under my toes. I read it eagerly but ended up none the wiser because the names used for the drug groups were unfamiliar to me. I consulted my copy of the British National Formulary,2 confident that the mystery would be solved. No luck: the terminology in the review wasn't used there.

    OK, I thought, I'll ask the pharmacist. But when he looked at the term I'd carefully copied from my BMJ his first assumption was that I'd got it wrong, because he had never heard of it either. Nor did any of his reference books mention it.

    The way that the authors classified the products that they discussed made the review far less useful than it could have been. What was needed was a simple table listing which products were included in each group (allylamines and azoles). I am surprised that the editors of the BMJ did not ask for this.

    The underlying problem is common in systematic reviews of research evidence: authors rarely seem to consider the practical application of the information that they gather so meticulously. Evidence based medicine requires effective communication between the reviewers of research and those who would implement it; one crucial aspect of this is choosing terms that are actually used and understood by potential readers.

    References

    1. 1.
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    Authors' reply

    1. Fay Crawford, MRC fellow (fc5{at}york.ac.uk),
    2. Sally E M Bell Syer, research fellow,
    3. David J Torgerson, reader,
    4. Philip Young, biostatistician,
    5. Ian Russell, professor,
    6. Rachel Hart, research podiatrist,
    7. Stuart Barton, editor
    1. Porthmadog, Gwynedd LL49 9AN
    2. Department of Health Sciences and Clinical Evaluation, University of York, York YO10 5DD
    3. Podiatry Department, University of Wales Institute, Cardiff CF1 3NS
    4. Clinical Evidence, BMJ Publishing Group, London WC1H 9JR

      EDITOR—Melville's comments about our review in Clinical Evidence highlight an important issue. It was our aim to produce a comprehensive review of the evidence of effectiveness of creams to treat athlete's foot. We are therefore concerned that Melville couldn't find information about one of the drugs in the British National Formulary. Although she doesn't name the drug, we deduce that it was ciclopiroxolamine: this is the only drug in the review that is not mentioned in the formulary.1 It is not available in the United Kingdom.

      It was unfortunate that the pharmacist was unable to help; reference to Martindale. The Complete Drug Reference Guide would have shown that ciclopiroxolamine is sold as 13 different proprietary products in 10 countries worldwide (excluding the United Kingdom).2 Tolnaftate is sold as a single ingredient in 30 proprietary preparations in 11 countries and is one ingredient in a further 14 multi-ingredient products. Undecanoic acid is available as Mycil cream in the United Kingdom, but in seven other countries it has 16 different brand names. It can be found in 60 multi-ingredient products in 12 countries. A table of generic names for classes of drugs is a good idea and will be part of the update of the chapter in issue 6 of Clinical Evidence; a table listing brand names is simply impractical.

      The review on athlete's foot in Clinical Evidence aims at informing an international audience and a varied medical staff (dermatologists, general practitioners, nurses, pharmacists, and other professionals allied to medicine); all will have different levels of knowledge about antifungal preparations. They will often have access to a drug formulary in which this information is available, but a table of generic names for classes of drugs will certainly be helpful.

      References

      1. 1.
      2. 2.
      View Abstract