Which oral antifungal is best for toenail onychomycosis?
Terbinafine, 250 mg taken daily for 12 weeks, is the best regimen for toenail onychomycosis due to better clinical and mycologic cure rates, tolerability, and cost effectiveness (strength of recommendation [SOR]: A, meta-analyses). Clinical commentary This expensive treatment is not always a high priority In my practice of mostly uninsured patients, onychomycosis treatment is not a high priority. The recommended drug, terbinafine, is costly and not available as a generic. Since this is primarily a cosmetic problem, we usually don’t treat it in my population. In the rare case that someone is willing to pay out of pocket, however, I will now use terbinafine, based on this review. At one of my practices, itraconazole was available at a reduced price, but that discount is outweighed by the superior safety profile of terbinafine.
