Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

• DOI: 10.1111/myc.13683
• Publication Date: 2024-01-04T02:55:03Z
• Authors: Aditya K. Gupta; Boni Elewski; Warren S. Joseph; Shari R. Lipner; C. Ralph Daniel; Antonella Tosti; Eric Guenin; Mahmoud Ghannoum
• Keywords: Terbinafine; Antifungal drugs; Antifungal drugs; Dermatophyte; Posaconazole

Abstract A growing body of literature has marked the emergence and spread antifungal resistance among species Trichophyton , most prevalent cause toenail fingernail onychomycosis in United States Europe. We review published data on rates oral species; causes methods to counteract it; vitro role topical antifungals treatment onychomycosis. Antifungal against terbinafine itraconazole—the two common treatments for other superficial fungal infections caused by dermatophytes—has been detected around globe. Fungal adaptations, patient characteristics (e.g., immunocompromised status; drug–drug interactions), empirical diagnostic patterns may contribute reduced efficacy development resistance. stewardship efforts aim ensure proper use limit improve clinical outcomes. In onychomycosis, critical aspects include identification infection prior initiation improvements physician education. Topical ciclopirox, efinaconazole tavaborole, delivered either alone or combination with antifungals, have demonstrated susceptible and/or resistant isolates species, low potential Additional real‐world long‐term are needed monitor global assess combination, counteracting