Once weekly fluconazole is effective in children in the treatment of tinea capitis: a prospective, multicentre study

Abstract

In an open, multicentre evaluation carried out in Brazil, Canada and South Africa we have demonstrated that fluconazole 8 mg kg-1 once weekly is effective in tinea capitis caused by Trichophyton and Microsporum species. There were 61 children, aged (mean +/- SE) 5.0 +/- 0.3 years; weight (mean +/- 5.6) 20.0 +/- 0.9 kg; 41 males, 20 females; one Asian, 57 Black, one Caucasian and two Hispanic. The organisms were Trichophyton violaceum (33 patients), T. tonsurans (11) and Microsporum canis (17). The extent of tinea capitis at pretherapy was: mild (18 patients), moderate (30) and severe (13). Patients with tinea capitis due to Trichophyton species were initially treated for 8 weeks with an extra 4 weeks of fluconazole if clinically indicated. All 44 patients with tinea capitis due to Trichophyton species were completely cured (clinically and mycologically) when evaluated 8 weeks after completion of active treatment, following 8 weeks of once weekly dosing in 35 patients and 12 weeks of once weekly dosing in nine patients. In Microsporum canis tinea capitis, an extra 4 weeks was administered at week 12 in patients where it was clinically indicated at the time. Sixteen of 17 patients with M. canis tinea capitis were completely cured (clinically and mycologically) when evaluated 8 weeks following the end of treatment when given for 8, 12 and 16 weeks in 12, one and three patients, respectively. Overall, complete cure (clinical and mycological) occurred in 60 of 61 patients at follow-up 8 weeks from the end of therapy. The duration of once weekly fluconazole in the 60 patients was 8 weeks (47 patients), 12 weeks (10 patients) and 16 weeks (three patients), respectively. Clinical adverse effects consisted of a mild, reversible gastrointestinal complaint in three (4.9%) of 61 children. A laboratory abnormality with elevated liver function tests was observed in one (5.9%) of 17 patients; this was asymptomatic, and reversible. No patient discontinued therapy. The data suggest that once weekly fluconazole dosing is effective, safe and associated with high compliance when used to treat tinea capitis.

Isolation of Trichophyton violaceum and Trichophyton soudanense in Baltimore, Maryland

“…Two patients reportedly had resolution of their infections without specific therapy. This observation of a high cure rate is in accordance with findings from a trial of once-weekly fluconazole for the treatment of tinea capitis in 61 children in Brazil, Canada, and South Africa (11). A complete cure 8 weeks after therapy was seen in 98% of children.…”

“…A complete cure 8 weeks after therapy was seen in 98% of children. Interestingly, almost half of these children had infection due to T. violaceum, while just 18% had infection due to T. tonsurans (11). Another trial of griseofulvin (20 mg/kg/day for 6 weeks), terbinafine, itraconazole (5 mg/kg/day for 2 to 3 weeks), and fluconazole (6 mg/ kg/day for 2 to 3 weeks) for the treatment of tinea capitis in Canada and South Africa showed 100% response rates in each of the four treatment arms among subjects with disease due to T. violaceum, compared to rates of 80 to 92% for subjects with disease due to T. tonsurans (10).…”

A randomized controlled trial assessing the efficacy of fluconazole in the treatment of pediatric tinea capitis

“…On the basis of its apparent success in previous studies, [14][15][16][17] it was hypothesized that fluconazole might have a therapeutic effect that was superior to that of griseofulvin. We used a randomized, multicenter, third-party-blind superiority study to test this hypothesis; to verify the safety, efficacy, and optimal duration of fluconazole therapy in children with tinea capitis; and to compare the efficacy of fluconazole to that of standard-dose griseofulvin.…”

Treatment of Tinea Capitis

“…In another comparative study, 6 mg/kg of fluconazole for 2–3 weeks performed slightly inferior to other antifungal agents such as 3–5 mg/kg of terbinafine for 2–3 weeks and 5 mg/kg of itraconazole for 2–3 weeks [50, 62]. The mycological cure rate for Trichophyton species was 79.5% with the use of 8 mg/kg/week of fluconazole for 8 weeks and increased to 100% with an additional week of therapy [63]. …”