TREATMENT OF TINEA-CAPITIS WITH ITRACONAZOLE CAPSULE PULSE THERAPY

Background: The number of newly diagnosed cases of tinea capitis in ch ildren appears to be on the rise, particularly in urban centers. Objec tive: The purpose of this study was to assess the effectiveness, safet y, and compliance of itraconazole pulse therapy for tinea capitis. Met hods: Fifty subjects (48 children [less than 18 years of age] and 2 ad ults) with tinea capitis were treated with pulse itraconazole in a mul ticenter evaluation. Each pulse lasted 1 week, with 2 weeks between th e first two pulses and 3 weeks between the second and third pulses. Th e decision to administer a second or third pulse was determined by the response of the subject at the time that the next pulse was due. Duri ng the 1-week pulse of active therapy, itraconazole (5 mg/kg/day) was dosed as follows: more than 40 kg, 200 mg per day (two capsules per da y); 20 to 40 kg, 100 mg per day (one capsule per day); and 10 to 19 kg , 50 mg per day (one half of a capsule per day). The duration of the s tudy was 12 weeks with mycologic evaluation at this time. Subjects who were classified as treatment failures at 12 weeks after the start of therapy were given the option of receiving an additional 1-week pulse of active therapy, with 3 weeks between successive pulses. Results: Th e causative organisms were Trichophyton tonsurans (41 subjects), T. vi olaceum (7), T. soudanense (1), and 1: rubrum (1). Thirteen subjects w ere lost to follow-up, with 37 subjects (35 children and 2 adults) ava ilable for evaluation 12 weeks after the start of therapy, At this tim e, cure (clinical and mycologic) was observed in 30 (81%) of 37 subjec ts. When the tinea capitis was mild, cure was obtained after one pulse in two subjects and after two pulses in five subjects. With tinea cap itis of moderate extent, complete cure was obtained after one pulse in one subject, two pulses in eight subjects, and after three pulses in seven subjects. When tinea capitis was severe, two and three pulses pr oduced complete cure in one and six subjects, respectively. Of the sev en subjects whose conditions failed to respond (three subjects with mo derate disease and four subjects with severe disease), five subjects c hose to receive extra itraconazole. Clinical and mycologic cure was ob served after four pulses in four subjects and after five pulses in one subject. There were no associated clinical adverse effects with itrac onazole therapy. Conclusion: With tinea capitis, itraconazole pulse th erapy is effective and safe and is associated with high compliance. Th e pulse regimen enables the duration of treatment to be individualized , according to the extent of disease and its rate of resolution.