Two randomized controlled trials (RCTs) provide limited evidence to support the use of itraconazole or terbinafine as first-line treatments for onychomycosis due to non-dermatophyte moulds.

• A single-blinded RCT (n = 59) compared the efficacy of five oral drugs in the treatment of moderate-to-severe toenail onychomycosis due to Scopulariopsis brevicaulis [Gupta and Gregurek-Novak, 2001]. No statistical comparisons were made between the different treatments. The treatment regimens and global cure rates (both clinical and mycological cure) at 12 months were:
• Griseofulvin, 600 mg twice daily for 12 months — 0 of 12 people cured.
• Ketoconazole, 200 mg daily for 4 months — 8 of 12 people cured.
• Itraconazole, pulsed therapy given as three pulses (pulses of 200 mg twice daily for 1 week, with 3 weeks off between pulses) — 12 of 12 people cured.
• Terbinafine, 250 mg daily for 12 weeks — 11 of 12 people cured.
• Fluconazole, 150 mg daily for 12 weeks — 8 of 12 people cured.
• A double-blind RCT (n = 97) compared the efficacy of terbinafine, 250 mg daily for 12 weeks or 24 weeks, with placebo for the treatment of onychomycosis [Lebwohl et al, 2001].
• Of the 97 participants, 30% had evidence of non-dermatophyte infection alone and the remainder had mixed infection with non-dermatophytes and dermatophytes. Candida species accounted for over a third of non-dermatophyte isolates. Alternaria species and Aspergillus species accounted for most of the other non-dermatophyte isolates, but numbers were small. No statistical comparisons were made between the different groups or between active and placebo treatments.
• No cures occurred in the placebo group, but the results for terbinafine suggested that it is likely to be effective in the treatment of onychomycosis due to mixed non-dermatophyte and dermatophyte infection or onychomycosis due to non-dermatophyte infection alone. The results are not discussed further due to the methodological limitations of this study.