Therapeutic options for the treatment of tinea capitis caused by trichophyton species: Griseofulvin versus the new oral antifungal agents, terbinafine, itraconazole, and fluconazole

Tinea capitis is a relatively common fungal infection of childhood. Griseof ulvin has been the mainstay of management. However, newer oral antifungal a gents are being used more frequently. A multicenter, prospective, randomize d, single-blinded, non-industry-sponsored study was conducted in centers in Canada and South Africa to determine the relative efficacy and safety of g riseofulvin, terbinafine, itraconazole, and fluconazole in the treatment of tinea capitis caused by Trichophyton species. The regimens for treating ti nea capitis were griseofulvin micro-size 20 mg/kg/day x 6 weeks, terbinafin e [> 40 kg, one 250 mg tablet; 20-40 kg, 125 mg (half of a 250 mg tablet); < 20 kg, 62.5 mg (one-quarter of a 250 mg tablet)] x 2-3 weeks, itraconazol e 5 mg/kg/day x 2-3 weeks, and fluconazole 6 mg/kg/day x 2-3 weeks. Patient s were asked to return at weeks 4, 8, and 12 from the start of the study. G riseofulvin was administered for 6 weeks and the final evaluation was at we ek 12. Terbinafine, itraconazole, and fluconazole were administered for 2 w eeks and the patient evaluated 4 weeks from the start of therapy. At this t ime, if clinically indicated, one extra week of therapy was given. There we re 200 patients randomized to four treatment groups (50 in each group). At the final evaluation at week 12, the number of evaluable patients were gris eofulvin, 46; terbinafine, 48; itraconazole, 46; and fluconazole, 46. Patie nts who discontinued therapy or were lost to follow-up were griseofulvin, 1 /3; itraconazole, 0/4; terbinafine, 0/4; and fluconazole, 0/4. The causativ e organisms were Trichophyton tonsurans and T. violaceum species. Patients were regarded as effectively treated at week 12 if there was mycologic cure and either clinical cure or only a few residual symptoms. Effective treatm ent was recorded in, intention to treat, griseofulvin (46 of 50, 92.0%), te rbinafine (47 of 50, 94.0%), itraconazole (43 of 50, 86.0%), and fluconazol e (42 of 50, 84.0%) (p = 0.33). Adverse effects were reported only in the g riseofulvin group (gastrointestinal effects in six patients). Discontinuati on from therapy due to adverse effects occurred only in the griseofulvin gr oup (nausea in one patient). For the treatment of tinea capitis caused by t he Trichophyton species, in this study, griseofulvin given for 6 weeks is s imilar in efficacy to terbinafine, itraconazole, and fluconazole given for 2-3 weeks. Each of the agents has a favorable adverse-effects profile.