How do you approach patients with onychomycosis that does not respond to terbinafine and prolonged courses of fluconazole?
Would you switch to itraconazole or perform fungal cultures?
Answer from: at Academic Institution
Terbinafine is usually effective in the treatment of the most common nail infections. Failure of treatment with terbinafine and fluconazole should make us consider bacterial co-infection or other non-dermatophyte organisms (i.e., aspergillus or non-C albicans). Fungal cultures are often falsely nega...
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Answer from: at Academic Institution
The vast majority of patients with mycologically confirmed onychomycosis will obtain complete cure with terbinafine. If a patient fails terbinafine, I would recommend performing culture or PCR to confirm the identity of the organism.