Don’t always treat fungal infections, says DTB
Fungal nail infections do not necessarily warrant treatment, the Drug
and Therapeutics Bulletin has concluded (2008;46:7).
It warns: “The long duration of treatment, the fact that a cure
cannot be guaranteed and the potential unwanted effects of antifungal
therapy (especially systemic treatment) will influence whether or not
the patient wishes to embark on such therapy.”
Where antifungal treatment is considered necessary, systemic treatment
with oral terbinafine (typically for six weeks to three months for infected
fingernails and three to six months for toenails) is cheap and is most
likely to achieve a cure, the DTB says.
It adds that oral itraconazole is more expensive and may be useful against
Candida spp but has a high relapse rate. Topical therapy lacks evidence
but may be useful in superficial white onychomycosis or where systemic
therapy is contraindicated.
Combination therapy may be useful to tackle infections resistant to monotherapy,
the DTB adds, although there is insufficient evident to justify nail
debridement plus topical or systemic therapy.
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