From the Guidelines
Treatment for onychomycosis should be initiated with terbinafine as the first-line treatment, due to its superior efficacy and lower risk of drug interactions compared to itraconazole, as reported in the British Association of Dermatologists' guidelines for the management of onychomycosis 2014 1.
Key Considerations
- The goal of antifungal therapy in onychomycosis is to achieve fungal-free nails, which can take up to 18 months for the nail plate to grow out fully 1.
- Factors contributing to treatment failure include nail thickness, slow outgrowth, severe onycholysis, and dermatophytoma, which may require additional interventions such as debridement or surgical removal of the lesion 1.
- To prevent recurrence, patients should be advised to wear protective footwear, apply antifungal powders, and keep their nails short, as well as avoid sharing toenail clippers and treat all infected family members simultaneously 1.
Treatment Options
- Terbinafine is the recommended first-line treatment for onychomycosis due to its superior efficacy and safety profile 1.
- Itraconazole is an alternative treatment option, but it has a higher risk of drug interactions and lower efficacy compared to terbinafine 1.
- Surgical avulsion, photodynamic therapy, and laser treatment are not currently recommended as primary treatments for onychomycosis due to limited evidence and variable results 1.
From the Research
Treatment Options for Pain
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain 2
- Topical NSAIDs are recommended for non-low back, musculoskeletal injuries 2
- Ibuprofen was consistently superior to paracetamol at conventional doses in a range of painful conditions, including acute post-operative pain, dysmenorrhoea, tension-type headache, migraine, osteoarthritis, and rheumatoid arthritis 3
- Acetaminophen is well tolerated, but lower doses should be used in patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder 2
Chronic Pain Treatment
- There is little evidence to support the efficacy of acetaminophen treatment in patients with chronic pain conditions 4
- Acetaminophen is often recommended as first-line treatment in all pain conditions, but its efficacy in chronic pain is dubious 4
- Ibuprofen may be a more effective option for chronic pain management, but further research is needed to confirm this 3
Clinical Decision Making
- Clinical recommendations should be based on medical evidence and patients' values and preferences 5
- Physicians' bias can influence clinical recommendations, and a transparent decision-making process is essential to improve the quality of healthcare decisions 5
- Patients' preferences for care should be considered, and physicians should decide whether to prioritize a welfare-enhancing or autonomy-enhancing approach when patients' preferences do not prioritize health 5
Comparison of Treatment Options
- Ibuprofen and acetaminophen are equally effective in reducing fever in febrile children, but ibuprofen may be more effective at higher doses 6
- Lower doses of ibuprofen (2.5 and 5 mg/kg) were less effective than acetaminophen and 10-mg/kg ibuprofen therapy after the initial dose, but were at least equally effective as these two higher-dose regimens thereafter 6