for more proximal or extensive onychomycosis topical treatments are unlikely to be effective and systemic treatment should be considered
the systemic treatment of choice is Terbinafine 250mg daily. This should be continued for between 6 weeks and 3 months in fingernail infection, or for 3 to 6 months in toenail onychomycosis (1). Further cultures might be taken at 3 months to assess the necessity for prolonged treatment. In cases of toenail dystrophy a nail paint may also be added in. The success of treatment is of cure in 80-95% of cases. Terbinafine interacts with relatively few other drugs and is generally well tolerated
alternative systemic treatments for dermatophyte onychomycosis include
Itraconazole as pulsed therapy - 200mg twice daily for 1 week a month for 2 months in fingernail and for 3 months in toenail infections
Griseofulvin 10mg/kg/daily for 6-9 months in fingernail infection or 15-18 months for toenails (no longer considered as a treatment option for dermatophyte infections)
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