Fluconazole and Ketoconazole

Dear Ask The Doctor:  I have a resistant ringworm infection and have seen a few different doctors about it. First one prescribed cream...no fix. Second prescribed 2 weeks ketoconazole...no fix. Third prescribed 1 month ketoconazole...no fix... Went back and he prescribed me another month of ketoconazole (all 200mgday). But since I was in the emergency room on an unrelated injury and decided to ask the doctor about fluconazole because I read online that it is less toxic and sometimes better to treat ringworm...So this forth doctor at the emergency room prescribed me a month of fluconazole 50mgday. Now I've read that fluconazole should be prescribed at 150mg to 200mgday. So like what the heck? I'm losing faith in doctors. I understand that ketoconazole can be prescribed for up to 6 months in some cases, and I've succumbed to thinking that's what I'll be doing...but my question is can I take the fluconazole 50mgday WITH the ketoconazole? I mean they both supposedly are broad spectrum antibiotics, but on the sixth week of ketoconazole 200mgday... the infection has only spread from my inner thighs to almost my entire skin area that covers my boxers...ass and hips and belt-line. (strangely the penis and testicles have been unaffected!) HELP PLEASE...this is really starting to affect my mental and physical health, as I haven't been able to swim (big swimmer), or have sex! (yikes)

Dear Patient:  If ringworm of the body covers a large area, is severe or doesn't respond to some anti-fungals, then I would suggest you taking oral anti-fungals.
Fluconazole or Terbinafine might be used. I would agree with your doctor’s Fluconazole dosage of 50mg per day to treat skin fungal infections. However 28 days might not be enough and this could e be extended after an evaluation. On the other hand, remember that even if you are receiving medication, you must keep the compromised area dry and cool, clean and avoid sharing personal items. I would suggest you to continue the treatment t as indicated, and make an appointment for a follow up visit, your doctor might continue with the same antifungal or probably change it to a stronger one such as Terbinafine. I wish you a prompt recovery.

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