Terbinafine 250 mg once daily — 12 weeks on, 12 weeks off, 4 weeks on — is preferred for onychomycosis in adults

Clinical Question

What is the best oral monotherapy for toenail onychomycosis in adults?

Bottom line

Based on efficacy, safety, and cost, a regimen of terbinafine 250 mg once daily for 12 weeks, followed by a 12-week period of no therapy, and then a 4-week booster of terbinafine 250 mg was preferred for onychomycosis in adults for the outcome of complete cure at 1 year. (LOE = 1a-)

This POEM aligns with the Canadian Dermatology Association’s Choosing Wisely Canada recommendation: Don’t prescribe systemic anti-fungals for suspected onychomycosis without mycological confirmation of dermatophyte infectionem.

Study design: Meta-analysis (randomized controlled trials)

Funding: Self-funded or unfunded

Setting: Outpatient (any)

Reviewer

Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA


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Comments

ARUP KUMAR DHARA

Impact assessment

Excellent

Anonymous

No mention of my go to

There was no mention, at least in the synopsis , of my go to, that is Itraconazole 200 BID for 7 days, 21 days off with 2 repeats

Anonymous

Onychomycosis

Excellent review and very relevant affecting many patients
I appreciated cost consideration comment

Anonymous

Oral therapy for onychomycosis

Good information about a successful regimen for nail fungus.

Anonymous

terbinafine 250mg for onychomycosis

good to know