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A random comparative study of terbinafine versus griseofulvin in patients with tinea capitis in Western China
1Department of Dermatology, First Hospital and Xinjiang Medical University, Urumqi, Xinjiang Province, People's Republic of China.
Insights
A 2-week course of terbinafine is as effective as a 4-week course of griseofulvin for treating tinea capitis (scalp fungal infection). This study found terbinafine to be a well-tolerated and effective alternative for Trichophyton infections.
Area of Science:
- Dermatology
- Mycology
- Infectious Diseases
Background:
- Tinea capitis is a common superficial fungal infection affecting children.
- Griseofulvin has been a standard treatment, but concerns about efficacy and duration exist.
- Terbinafine offers a newer therapeutic option with potential for shorter treatment durations.
Purpose of the Study:
- To compare the efficacy and safety of terbinafine versus griseofulvin in treating tinea capitis in children.
- To evaluate different treatment durations for terbinafine (2 and 4 weeks) against a 4-week griseofulvin regimen.
Main Methods:
- A randomized controlled trial involving children aged 2-14 years with confirmed tinea capitis.
- Three treatment groups: 4 weeks of griseofulvin, 2 weeks of terbinafine, and 4 weeks of terbinafine.
- Clinical and mycological assessments at multiple time points, including 1-year follow-up. In vitro antifungal susceptibility testing was also performed.
Main Results:
- All treatment groups showed high clinical effectiveness (100% at 1 year).
- Clinical cure rates at 8 weeks were comparable: 84.2% for griseofulvin, 85.2% for 2-week terbinafine, and 78.3% for 4-week terbinafine.
- Mycological cure rates at 8 weeks were also high and similar across groups (94.1-100%). In vitro, all isolates were sensitive to tested antifungals.
Conclusions:
- A 2-week course of terbinafine is as effective and well-tolerated as a 4-week course of griseofulvin for tinea capitis caused by Trichophyton species.
- Terbinafine represents an effective alternative treatment for tinea capitis, offering a shorter duration of therapy.
Objective:
To compare the efficacy and safety of terbinafine with griseofulvin in the treatment of tinea capitis in Western China.
Methods:
Children (2-14 years of age) with clinically diagnosed and potassium hydroxide microscopy-confirmed tinea capitis were randomized into three groups: group GRI4 received 4 weeks of griseofulvin; group TBF2 received 2 weeks of terbinafine; and Group TBF4 received 4 weeks of terbinafine. Clinical and mycological evaluations were done in 0, 2, 4, and 8 weeks and 1 year after therapy started. The isolated pathogenic fungi were evaluated for in vitro susceptibility by detecting the minimal inhibitory concentration (MIC) against terbinafine, griseofulvin, itraconazole, and ketoconazole.
Results:
The clinical effectiveness rate of GRI4, TBF2, and TBF4 were 100% (95% CI-confidence interval: 82-100%), 96.3% (95% CI: 81-100%), and 100%(95% CI: 85-100%), respectively, at week 8 and 100% after 1 year for the 3 groups; clinical cure rates were 84.2%(95% CI: 77-99%), 85.2%(95% CI: 71-98%), and 78.3%(95% CI: 61-95%), respectively, at week 8 and 100% after 1 year for all agents; mycological cure rates were 100%(95% CI: 74-100%), 95.0%(95% CI: 74-100%), and 94.1%(95% CI: 50-93%) at week 8 and 100% after 1 year for the 3 groups. In vitro, all patient-derived cultures were sensitive to the four antifungal agents.
Conclusion:
Data from the clinical trial and in vitro antifungal activity indicated that terbinafine is efficacious and well tolerated in the treatment for Trichophyton infections (T. violaceum; Arthroderma vanbreuseghemii; and T. tonsurans) of the scalp, i.e., a 2- to 4-week course of terbinafine is as effective as a 4-week course of griseofulvin; in fact, a 2-week course of terbinafine is sufficient. Terbinafine is an effective alternative to griseofulvin against tinea capitis of Trichophyton infections.
