Optimizing the therapeutic approach in tinea capitis of childhood with itraconazole

Background Tinea capitis is the most common dermatophytosis of childhood wi th increasing incidence. Whereas griseofulvin is considered by many as the mainstay of treatment, newer oral antifungal agents, including fluconazole, itraconazole and terbinafine have demonstrated higher efficacy, resulting in shorter treatment durations. Objectives We aimed to determine the optimum regimen for the treatment of c hildhood tinea capitis with itraconazole. Methods A mycological culture outcome-dependent combination of a 28-day con tinuous and facultative additional 14-day courses with itraconazole was use d in 42 children (20 girls; 22 boys) aged 12-140 months (mean 66) with tine a capitis due to Microsporum canis (n = 26) and Trichophyton violaceum (n = 16). The drug was given orally according to the patients' body weight (50 mg daily for < 20 kg; 100 mg daily for greater than or equal to 20 kg) over 4 weeks. Direct microscopy and fungal culture as a parameter for efficacy were repeated 2 weeks after termination of treatment. Assessment of efficac y was based on the evaluation of results from light microscopy and culture at 8 weeks after initiation of treatment, and in the case of a further posi tive mycological culture at 14 and 20 weeks, respectively. A positive funga l culture at these times resulted in an additional course for 2 weeks with the initially chosen itraconazole dosage. Results In 34 of 42 patients a single 4-week course of itraconazole resulte d in a complete mycological cure of lesions as demonstrated by light micros copy and mycological culture. Four of 42 patients had to be treated by a se cond itraconazole course for 2 weeks, and four children received a third co urse of itraconazole for 2 weeks until all lesions showed negative direct m icroscopy and mycological culture. No abnormal haematological or biochemica l results occurred. Apart from transient, completely reversible indigestion in two children, no side-effects were observed. Conclusions A culture-based 28-day continuous therapeutic regimen plus facu ltative cultural outcome-dependent additional 14-day courses of a body weig ht-adapted dosage of itraconazole in tinea capitis due to M. canis and T. v iolaceum is discussed; this offers the advantage of an effective therapy wi th complete negative direct microscopy as well as negative cultural results , within a shorter active treatment period (cf. previous studies with conti nuous administration of itraconazole).