What are the recommended first-line treatments for onychomycosis in adults according to current UK guidelines?

For adults with confirmed dermatophyte onychomycosis, the recommended first-line treatment is oral terbinafine 250 mg once daily for 6 weeks for fingernails and 12-24 weeks for toenails, with visible improvement typically seen after 2 months of fingernail treatment and 3 months of toenail treatment ¹.

In cases of confirmed Candida or non-dermatophyte nail infection, first-line treatment is oral itraconazole, administered as pulsed therapy of 200 mg twice daily for 1 week, with subsequent courses repeated after 21 days, for 2 pulses for fingernails and 3 pulses for toenails ¹.