Could Toenail Fungus Be Bacterial Infection? Neosporin Cure?

We have been writing about toenail fungus for over 30 years. That’s because fungal infections of the nails are both common and hard to treat. They require patience and persistence. Home remedies are inexpensive and sometimes work as well or better than prescription treatments. And sometimes a “fungal” infection may actually be a bacterial infection or both bacterial and fungal. Readers share their success with the Neosporin cure!

A Common Question About Nail Fungus:

Q. Can you recommend a good cure for toenail fungus? I have tried various over-the-counter remedies without success.

A. After three decades, this common question might be boring. Au contraire! Even after all this time, the extraordinary variety of treatments people try to get rid of nail fungus continues to amaze us.

Here is a link to our post: How to Cure Toenail Fungus

You will read about prescription drugs, lasers and home remedies.

Over-the-Counter Antibiotic Ointment Overcomes Nail Infection:

Q. My podiatrist last year told me that not all toenail infections are fungal in origin. Apparently, some toenail infections are bacterial instead.

For two weeks, I applied Neosporin + Pain Relief Ointment with a cotton swab to each infected toenail and the surrounding cuticle. After that, I reduced the application to weekly. It has been months now, and the disfiguring infection has disappeared and not returned.

A. For decades, we believed that most nail infections were caused by fungi (dermatophytes) such as Trichophyton rubrum or T. mentagrophytes. Other causes included Epidermophyton floccosum or the yeast Candida albicans.

More recently, however, dermatologists have learned that bacteria are responsible, in part, for some nail infections (Journal of the American Podiatric Medical Association, March 1, 2021).  Some readers have been reporting success with the antibiotics in Neosporin (neomycin, polymyxin B). Others tell us that Polysporin (bacitracin, polymyxin B) also works in some cases.

A dermatologist would need to identify the organisms causing a nail infection to recommend the most effective treatment.

Comparing Rx Drugs to Home Remedies:

Clearly, no single solution for nasty nails works for everyone. The FDA has approved several prescription products. However, according to a published review, the cure rates are unimpressive.

Itraconazole taken as a pill resulted in a complete cure about 14 percent of the time after nearly a year (F1000Research, June 25, 2019). Over the same 48 weeks of treatment, terbinafine pills cured 38 percent of nail fungus cases.

Topical medicines were less effective. Tavaborole (Kerydin) had a cure rate of 6.5 percent, ciclopirox (Loprox, Penlac) got up to 8.5 percent and efinaconazole (Jublia) to 17.8 percent.

It’s not surprising that many readers try home remedies. Like prescriptions, they don’t work for everyone. Here is a link to several inexpensive home remedies.

The Neosporin Cure for Nail “Fungus”

One reader recently shared this experience with an OTC antibiotic for thick, hard toenails:

“I tried home remedies for nail fungus with limited results. OTC liquids and athlete’s foot creams didn’t work either. The fungus always returned. Oral Lamisil helped, but I had to stop it due to abnormal liver function tests.

“A few weeks ago, you wrote about Neosporin for stubborn nail fungus (here is a link). So I tried it.

“Almost overnight, my nails look better than they have in twenty-plus years! The thick, whitish-yellow, crusty, crumbly nails are now pink and healthy looking. Black spots on two smaller toes are growing out. My podiatrist was amazed.”

Why Would the Neosporin Cure Work for Fungus?

Not all infections of the nails are caused by fungus. Bacteria help cause a surprising proportion (Journal of the American Podiatric Medical Association, March 1, 2021).

Here is what the authors did:

“Thirty-nine consecutive nail and subungual debris samples with suspected onychomycosis  [nail fungus] were sent for laboratory analysis using three examination techniques: DNA sequencing, polymerase chain reaction analysis, and standard fungal culture.

“Results: The DNA sequencing detected 32 species of bacteria and 28 species of fungi: 50% were solely bacterial, 6.3% were solely fungal, and 43.7% were mixed communities of bacteria and fungi.

“Conclusions: Toenails tested with DNA sequencing demonstrated the presence of both bacteria and fungi in many samples.”

A study published in the Journal of Cosmetic Dermatology (July, 2021) also found:

“Of 53 patients included in the study, 39 were female (73.6%) and 14 were male (26.4%). The ages of the patients ranged from 14 to 70 years, and the mean age was 37.8 years. No fungi could be isolated in 17 (32%) patients with nail dystrophy, while fungal pathogens were observed in 36 (68%) patients…

“Conclusion: Although fungal pathogenic agents are mostly detected among the diseases causing color changes and deformities in the nails, it should be kept in mind that nail findings of systemic or other skin diseases may mimic onychomycosis and the diagnosis should be confirmed by laboratory tests in addition to clinical manifestations for accurate treatment.”

Disappointment–Neosporin Cure Did Not Work:

We received a response to this post from a disappointed reader.

Q. About a month ago, someone wrote you that Neosporin cleared up their toenail fungus in short order. I’ve been on prescription ciclopirox for three years without results. I tried Neosporin ointment for a month and got absolutely no help.

You need to fully investigate these claims by people. If they don’t work, print a retraction!

A. We understand your frustration, but even the most powerful FDA-approved prescription drugs to treat nail fungus don’t work all the time. And they usually take up to a year for a complete cure.

People may assume that a toenail infection is caused by a fungal infection, but that is not always true. Bacteria and fungi together cause many cases, while fungus alone cause a minority of cases.

Topical medicines like ciclopirox cure less than 12 percent of infections after almost a year. That’s not very impressive.

The reader who got good results with Neosporin used it on the recommendation of a podiatrist who had tested the nails. A bacterial infection had caused that nail problem. Perhaps the Neosporin cure won’t work in every case of bacterial infection, but it is inexpensive and worth a try.

The Bottom Line on Nail Infections:

It appears to us that either fungi or bacteria can cause nail nastiness. So far, we have only seen a few stories about a Neosporin cure for nail infection. It will be interesting to see if some hard-to-treat nail infections respond to antibiotics, presumably because bacteria are responsible for them. Only time and more stories from readers can shed light on this ongoing mystery.