A randomized, double-blind, parallel-group, duration-finding study of oral terbinafine and open-label, high-dose griseofulvin in children with tinea capitis due to Microsporum species

Abstract

Although there was no statistical trend between the duration of terbinafine treatment within the groups for complete cure at the end of study, there was a positive correlation between the daily dose of terbinafine (mg x kg(-1)) and complete cure. Terbinafine therapy for 6 weeks could represent an alternative to griseofulvin for the treatment of Microsporum tinea capitis. However, further clinical trials are required in order to optimize the dose regimen to allow higher cure rates to be reached.

Meta-analysis of randomized, controlled trials comparing griseofulvin and terbinafine in the treatment of tinea capitis

“…The duration of griseofulvin was 6 or 8 weeks except for one study (12 weeks). 6 The duration of terbinafine in 4 studies was 4 weeks; one study was 2 to 3 weeks 9 ; one study was 6 weeks 10 ; and another was 6 to 12 weeks. 6 All used daily dosing of the drugs.…”

“…One study was comprised entirely of Microsporum species 6 and another had similar proportions of Trichophyton and Microsporum species. 7 Overall, they included more Trichophyton compared with Microsporum species and T tonsurans and M canis were the predominant pathogens in their respective genus.…”

Treatment of Tinea Capitis

“…Terbinafine demonstrated superiority in treating T. tonsurans and a similar efficacy in treating T. violaceum , while griseofulvin was superior in treating M. canis and other Microsporum species [36, 40]. Lipozencic et al [41] showed that longer courses of terbinafine do not improve its efficacy against Microsporum species, concluding that terbinafine should not be a first line for tinea capitis infections caused by Microsporum species. In the US, these infections represent less than 5% of all cases of tinea capitis and should be suspected in cases with an ectothrix pattern or when contact with infected animals is found [5].…”

Update on terbinafine with a focus on dermatophytoses

“…[159][160][161] As above, the exception lies with infections caused by Microsporum where griseofulvin appears to be superior to terbinafi ne even when the allylamine is administered for 12 weeks. [160][161][162] Pulse regimens wherein the standard dose or double the standard dose of terbinafi ne is administered daily for 1 week (followed by 3 weeks off) do not appear to confer any advantage or disadvantage in the treatment of Microsporum infections over standard regimens.…”