Xiaomei Chen1, Xia Jiang1, Ming Yang2, Cathy Bennett3, Urbà González4, Xiufang Lin2, Xia Hua1, Siliang Xue1, Min Zhang5. 1. Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China. 2. Center of Geriatrics and Gerontology, West China Hospital, Sichuan University, Chengdu, China. 3. Center for Technology Enabled Health Research, Coventry University, Coventry, United Kingdom. 4. Unit of Dermatology, Clinica GO&FER, Barcelona, Spain. 5. Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China. Electronic address: lily666@medmail.com.cn.
Abstract
BACKGROUND: The comparative efficacy and safety profiles of systemic antifungal drugs for tinea capitis in children remain unclear. OBJECTIVE: We sought to assess the effects of systemic antifungal drugs for tinea capitis in children. METHODS: We used standard Cochrane methodological procedures. RESULTS: We included 25 randomized controlled trials with 4449 participants. Terbinafine and griseofulvin had similar effects for children with mixed Trichophyton and Microsporum infections (risk ratio 1.08, 95% confidence interval 0.94-1.24). Terbinafine was better than griseofulvin for complete cure of T tonsurans infections (risk ratio 1.47, 95% confidence interval 1.22-1.77); griseofulvin was better than terbinafine for complete cure of infections caused solely by Microsporum species (risk ratio 0.68, 95% confidence interval 0.53-0.86). Compared with griseofulvin or terbinafine, itraconazole and fluconazole had similar effects against Trichophyton infections. LIMITATIONS: All included studies were at unclear or high risk of bias. Lower quality evidence resulted in a lower confidence in the estimate of effect. Significant clinical heterogeneity existed across studies. CONCLUSIONS: Griseofulvin or terbinafine are both effective; terbinafine is more effective for T tonsurans and griseofulvin for M canis infections. Itraconazole and fluconazole are alternative but not optimal choices for Trichophyton infections. Optimal regimens of antifungal agents need further studies.
BACKGROUND: The comparative efficacy and safety profiles of systemic antifungal drugs for tinea capitis in children remain unclear. OBJECTIVE: We sought to assess the effects of systemic antifungal drugs for tinea capitis in children. METHODS: We used standard Cochrane methodological procedures. RESULTS: We included 25 randomized controlled trials with 4449 participants. Terbinafine and griseofulvin had similar effects for children with mixed Trichophyton and Microsporum infections (risk ratio 1.08, 95% confidence interval 0.94-1.24). Terbinafine was better than griseofulvin for complete cure of T tonsurans infections (risk ratio 1.47, 95% confidence interval 1.22-1.77); griseofulvin was better than terbinafine for complete cure of infections caused solely by Microsporum species (risk ratio 0.68, 95% confidence interval 0.53-0.86). Compared with griseofulvin or terbinafine, itraconazole and fluconazole had similar effects against Trichophyton infections. LIMITATIONS: All included studies were at unclear or high risk of bias. Lower quality evidence resulted in a lower confidence in the estimate of effect. Significant clinical heterogeneity existed across studies. CONCLUSIONS:Griseofulvin or terbinafine are both effective; terbinafine is more effective for T tonsurans and griseofulvin for M canis infections. Itraconazole and fluconazole are alternative but not optimal choices for Trichophyton infections. Optimal regimens of antifungal agents need further studies.