Meta‐Analysis of Randomized, Controlled Trials Comparing Particular Doses of Griseofulvin and Terbinafine for the Treatment of Tinea Capitis

Abstract

Two oral antifungal agents, griseofulvin and terbinafine, have regulatory approval in the United States, but it is unknown whether one has superior overall efficacy. Genus-specific differences in efficacy are believed to exist for the two agents. It is not clear at what doses and durations of treatment these differences apply. The goals of this meta-analysis were to determine whether a statistically significant difference in efficacy exists between these agents at a given dose and duration of each in tinea capitis infections overall and to determine whether a genus-specific difference in efficacy exists for these two treatments at a given dose and duration of each. We performed a literature search for clinically and methodologically similar randomized controlled trials comparing 8 weeks of griseofulvin (6.25-12.5 mg/kg/day) to 4 weeks of terbinafine (3.125-6.25 mg/kg/day) in the treatment of tinea capitis. A meta-analysis was performed using the Mantel-Haenszel method and random effects model; results were expressed as odds ratios with 95% confidence intervals. Meta-analysis of randomized controlled trials did not show a significant difference in the overall efficacy of the two drugs at the doses specified, but specific efficacy differences were observed based on the infectious species. For tinea capitis caused by Microsporum spp., griseofulvin is superior (p = 0.04), whereas terbinafine is superior for Trichophyton spp. infection (p = 0.04). Our results support species-specific differences in treatment efficacy between griseofulvin and terbinafine and provide a clinical context in which this knowledge may be applied.

Black dot tinea capitis caused by trichophyton rubrum in an adult female presenting with cicatricial alopecia

“…[7] A carrier in the household, usually a child, can also be a source of reinfection. Trichophyton species are more responsive to terbinafine than griseofulvin as seen in certain studies, [8,9] and the same was observed in our patient.…”

Treatment of Tinea Capitis

“…Multiple meta-analyses have demonstrated a similar efficacy for a 6-week course of griseofulvin and a 4-week course of terbinafine [17, 36, 39]. However, a difference in efficacy was found based on the infectious organism.…”

“…However, a difference in efficacy was found based on the infectious organism. Terbinafine demonstrated superiority in treating T. tonsurans and a similar efficacy in treating T. violaceum , while griseofulvin was superior in treating M. canis and other Microsporum species [36, 40]. Lipozencic et al [41] showed that longer courses of terbinafine do not improve its efficacy against Microsporum species, concluding that terbinafine should not be a first line for tinea capitis infections caused by Microsporum species.…”

“…The approved doses of terbinafine granules are based on body weight: 125.0 mg for less than 25 kg, 187.5 mg for 25–35 kg, and 250.0 mg for 35 kg or more, for continued duration of 6 weeks [35]. Laboratory monitoring for courses longer than 6 weeks may be required [36]. Most clinical trials have demonstrated a 4-week course of once-a-day dose to be effective in treating tinea capitis [17].…”

Kerion caused by Microsporum audouinii in a child

“…Griseofulvin is the treatment of choice for cases caused by Microsporum species, and it has a long-term safety profile [12]. Nevertheless, as it was not easily available for prescription in our country, we opted to give terbinafine, a broad-spectrum agent that have been shown to be comparable in efficacy and safety with griseofulvin, with good results in our patient and no adverse effects [10,11].…”