CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Fungal nail infection (onychomycosis) - Management
How should I manage failure to respond to treatment?
- Assess and, if possible, manage likely causes of treatment failure, namely:
- Poor adherence to advice and prescriptions.
- Poor absorption of oral drugs (such as with inflammatory bowel disease).
- Immunocompromise.
- Resistance of the infecting organisms to the antifungal agent.
- Failure of the nail to grow.
- Consider referral to a dermatologist or podiatrist. Assessment and treatment options that they may consider include:
- Obtaining better specimens for culture.
- Changing to another drug.
- Mechanical debridement.
- Complete or partial removal of the affected nail — this may require a local anaesthetic.
© NHS Institute for Innovation and Improvement