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Systemic antifungal therapy for tinea capitis in children.

Abstract

BACKGROUND

Tinea capitis is a common contagious fungal infection of the scalp in children. Systemic therapy is required for treatment and to prevent spread.

OBJECTIVES

To assess the effects of systemic anti-fungal drugs for tinea capitis in children.

SEARCH STRATEGY

We searched the Cochrane Skin Group Specialised Register (June 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (2003 to June 2005), EMBASE (2003 to June 2005), LILACS (1982 to July 2005), CINAHL (1982 to July 2005), the ACP journal club (1991 to July 2005) and Healthstar (1975 to July 2005).

SELECTION CRITERIA

Randomised controlled trials (RCTs) that evaluated systemic antifungal therapy in people with normal immunity under the age of 18 who had tinea capitis confirmed by microscopy or growth of dermatophytes in culture or both.

DATA COLLECTION AND ANALYSIS

At least two authors independently examined each retrieved trial for eligibility and quality.

MAIN RESULTS

We included 21 studies (1812 participants). Infections involving Trichophyton species: Terbinafine for four weeks and griseofulvin for eight weeks showed similar efficacy in 3 studies involving 382 participants (RR 1.09; 95% CI 0.95 to 1.26). Cure rates following treatment with itraconazole and griseofulvin for 6 weeks were similar in 1 study of 35 children (RR 1.06; 95% CI 0.81 to 1.39). Another study of 100 children did not show any significant difference in cure between itraconazole for 2 weeks compared with griseofulvin for 6 weeks (RR 0.89; 95% CI 0.76 to 1.04). There was no difference between itraconazole and terbinafine for treatment periods lasting 2 to 3 weeks in 2 studies involving 160 children (RR 0.93; 95% CI 0.72 to 1.19). Two studies that included 140 children found similar cure rates between 2 to 4 weeks of fluconazole with 6 weeks of griseofulvin (RR 0.92; 95% CI 0.80 to 1.05). Microsporum infections: There was no significant difference in cure between terbinafine and griseofulvin in children with Microsporum infections in 1 small study of 29 children (RR 0.64; 95% CI 0.19 to 2.20).

AUTHORS' CONCLUSIONS

The best evidence suggests that newer treatments including terbinafine, itraconazole and fluconazole may be similar to griseofulvin in children with tinea capitis caused by Trichophyton species. Newer treatments may be preferred because shorter treatment durations may improve treatment adherence, although they may be more expensive. There is not enough evidence on the use of systemic treatments in children with Microsporum infections. Not all treatments for tinea capitis are available in paediatric formulations but all have reasonable safety profiles.

Authors+Show Affiliations

Clinica Plato, Department of Dermatology, c/ Plato 21, Barcelona, Catalunya, Spain, 08006. urba.gonzalez@clinicaplato.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

17943825

Citation

González, U, et al. "Systemic Antifungal Therapy for Tinea Capitis in Children." The Cochrane Database of Systematic Reviews, 2007, p. CD004685.
González U, Seaton T, Bergus G, et al. Systemic antifungal therapy for tinea capitis in children. Cochrane Database Syst Rev. 2007.
González, U., Seaton, T., Bergus, G., Jacobson, J., & Martínez-Monzón, C. (2007). Systemic antifungal therapy for tinea capitis in children. The Cochrane Database of Systematic Reviews, (4), CD004685.
González U, et al. Systemic Antifungal Therapy for Tinea Capitis in Children. Cochrane Database Syst Rev. 2007 Oct 17;(4)CD004685. PubMed PMID: 17943825.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systemic antifungal therapy for tinea capitis in children. AU - González,U, AU - Seaton,T, AU - Bergus,G, AU - Jacobson,J, AU - Martínez-Monzón,C, Y1 - 2007/10/17/ PY - 2007/10/19/pubmed PY - 2008/1/18/medline PY - 2007/10/19/entrez SP - CD004685 EP - CD004685 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 4 N2 - BACKGROUND: Tinea capitis is a common contagious fungal infection of the scalp in children. Systemic therapy is required for treatment and to prevent spread. OBJECTIVES: To assess the effects of systemic anti-fungal drugs for tinea capitis in children. SEARCH STRATEGY: We searched the Cochrane Skin Group Specialised Register (June 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (2003 to June 2005), EMBASE (2003 to June 2005), LILACS (1982 to July 2005), CINAHL (1982 to July 2005), the ACP journal club (1991 to July 2005) and Healthstar (1975 to July 2005). SELECTION CRITERIA: Randomised controlled trials (RCTs) that evaluated systemic antifungal therapy in people with normal immunity under the age of 18 who had tinea capitis confirmed by microscopy or growth of dermatophytes in culture or both. DATA COLLECTION AND ANALYSIS: At least two authors independently examined each retrieved trial for eligibility and quality. MAIN RESULTS: We included 21 studies (1812 participants). Infections involving Trichophyton species: Terbinafine for four weeks and griseofulvin for eight weeks showed similar efficacy in 3 studies involving 382 participants (RR 1.09; 95% CI 0.95 to 1.26). Cure rates following treatment with itraconazole and griseofulvin for 6 weeks were similar in 1 study of 35 children (RR 1.06; 95% CI 0.81 to 1.39). Another study of 100 children did not show any significant difference in cure between itraconazole for 2 weeks compared with griseofulvin for 6 weeks (RR 0.89; 95% CI 0.76 to 1.04). There was no difference between itraconazole and terbinafine for treatment periods lasting 2 to 3 weeks in 2 studies involving 160 children (RR 0.93; 95% CI 0.72 to 1.19). Two studies that included 140 children found similar cure rates between 2 to 4 weeks of fluconazole with 6 weeks of griseofulvin (RR 0.92; 95% CI 0.80 to 1.05). Microsporum infections: There was no significant difference in cure between terbinafine and griseofulvin in children with Microsporum infections in 1 small study of 29 children (RR 0.64; 95% CI 0.19 to 2.20). AUTHORS' CONCLUSIONS: The best evidence suggests that newer treatments including terbinafine, itraconazole and fluconazole may be similar to griseofulvin in children with tinea capitis caused by Trichophyton species. Newer treatments may be preferred because shorter treatment durations may improve treatment adherence, although they may be more expensive. There is not enough evidence on the use of systemic treatments in children with Microsporum infections. Not all treatments for tinea capitis are available in paediatric formulations but all have reasonable safety profiles. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/17943825/Systemic_antifungal_therapy_for_tinea_capitis_in_children_ L2 - https://doi.org/10.1002/14651858.CD004685.pub2 DB - PRIME DP - Unbound Medicine ER -