Dermatophyte infection - nail
First line: terbinafine
250mg ODÂ
fingers: 6-12 weeks
toes: 3-6 months
Second line: itraconazole
200mg BD
fingers: 7 days monthly
toes: 2 courses
Third line for very superficial as limited evidence of effectiveness: amorolfine 5% nail lacquer
1-2x/weekly
fingers: 6 months
toes: 12 months
Take nail clippings: start therapy only if infection is confirmed by laboratory.
Oral terbinafine is more effective than oral azole.
Liver reactions rare with oral antifungals.
If candida or non-dermatophyte infection confirmed, use oral itraconazole.
For children, seek specialist advice.