From the Guidelines
For Candida parapsilosis toenail infections that haven't responded to Jublia, itraconazole should be considered the first-line treatment, given its shorter treatment duration and higher efficacy compared to terbinafine, as demonstrated in a study published in the British Journal of Dermatology 1.
Treatment Options
- Oral itraconazole 200mg daily or as pulse therapy (400mg per day for 1 week each month) for a minimum of 12 weeks for toenail onychomycosis is recommended, as it has shown higher cure rates compared to terbinafine 1.
- Alternatively, oral fluconazole 50mg per day or 300mg per week can be considered, as it is believed to be equally effective as itraconazole in the treatment of Candida onychomycosis 1.
- Terbinafine 250mg daily for 12-48 weeks can also be effective, but it requires a longer treatment period to achieve higher cure rates, especially for C. parapsilosis, with mycological cure rates of up to 85% after 48 weeks of treatment 1.
Additional Considerations
- During treatment, it is essential to keep nails short, dry, and clean, and consider using antifungal powders in shoes to prevent reinfection.
- Combination therapy using both oral and topical antifungals might improve outcomes in resistant cases, although there is limited evidence to support this approach.
- Complete cure requires patience as new, healthy nail must grow out, which takes several months.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Candida Parapsilosis
- Terbinafine has been shown to be effective in treating Candida nail infection, including Candida parapsilosis, with a clinical and mycological cure rate of 60% 2.
- The combination of fluconazole, itraconazole, and terbinafine with different culture extracts of Candida parapsilosis has been found to have a synergistic effect against Trichophyton rubrum, suggesting potential for new therapeutic approaches 3.
- Other antifungal drugs, such as itraconazole and fluconazole, may also be effective in treating Candida parapsilosis, although their efficacy and safety profiles may vary 4.
Considerations for Treatment
- The choice of treatment for Candida parapsilosis affecting the toenails that did not respond to Jublia (efinaconazole) may involve considering alternative antifungal agents, such as terbinafine or itraconazole 2, 4.
- The use of combination therapy, involving multiple antifungal agents, may also be considered to enhance treatment efficacy 3.
- It is essential to monitor liver enzyme values during treatment with terbinafine, as mild reversible elevation of liver enzymes has been reported in some patients 2.