Question:
What is the drug of choice for onychomycosis?
What is the drug of choice for onychomycosis?
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The fungicidal allylamine that concentrates in nail keratin wins here.
Updated On: Jun 23, 2026
- Terbinafine
- Fluconazole
- Nystatin
- Itraconazole
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The Correct Option is A
Solution and Explanation
Step 1: Onychomycosis is a fungal infection of the nail, usually caused by a dermatophyte. It is hard to treat because the nail grows slowly, so the drug must penetrate the nail keratin and persist there.
Step 2: Terbinafine is the drug of choice. It is fungicidal against dermatophytes, accumulates in nail keratin, and gives the highest cure rates with a good safety profile and shorter courses.
Step 3: Itraconazole is an effective alternative (often as pulse therapy). Fluconazole is less preferred. Nystatin is only useful topically for Candida and does not work for dermatophyte nail infection. Older agents like griseofulvin and ketoconazole have poor efficacy or toxicity.
Ref: NCBI / standard antifungal guidelines.
Step 2: Terbinafine is the drug of choice. It is fungicidal against dermatophytes, accumulates in nail keratin, and gives the highest cure rates with a good safety profile and shorter courses.
Step 3: Itraconazole is an effective alternative (often as pulse therapy). Fluconazole is less preferred. Nystatin is only useful topically for Candida and does not work for dermatophyte nail infection. Older agents like griseofulvin and ketoconazole have poor efficacy or toxicity.
Ref: NCBI / standard antifungal guidelines.
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