Systemic antifungal therapy for tinea capitis in children: An abridged Cochrane Review - 18/04/17

Doi : 10.1016/j.jaad.2016.08.061

Xiaomei Chen, MMS ^a, Xia Jiang, MMS ^a, Ming Yang, MD ^b, Cathy Bennett, PhD ^c, Urbà González, MD ^d, Xiufang Lin, MMS ^b, Xia Hua, MMS ^a, Siliang Xue, MD ^a, Min Zhang, MD ^a,^⁎
^a Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
^b Center of Geriatrics and Gerontology, West China Hospital, Sichuan University, Chengdu, China
^c Center for Technology Enabled Health Research, Coventry University, Coventry, United Kingdom
^d Unit of Dermatology, Clinica GO&FER, Barcelona, Spain

^∗Reprint requests: Min Zhang, MD, Department of Dermatology and Venereology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China.Department of Dermatology and VenereologyWest China HospitalSichuan UniversityNo. 37, Guo Xue XiangChengduSichuan610041China

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.

Le texte complet de cet article est disponible en PDF.

Key words : children, Cochrane, systemic antifungal therapy, systematic review, tinea capitis, treatment

Abbreviations used : CI, FDA, GRADE, RCT, RR

Plan

Terbinafine versus griseofulvin

Different treatment durations of terbinafine

Standard dose terbinafine versus double-dose terbinafine

Itraconazole versus griseofulvin

Itraconazole versus terbinafine

Ketoconazole versus griseofulvin

Fluconazole versus griseofulvin

Fluconazole versus terbinafine

Fluconazole versus itraconazole

Different dosages of fluconazole

Short-term versus medium-term fluconazole

Discussion

	This article has no funding sources. However, the original version of the Cochrane Review was funded by the Cochrane Skin Group; Cochrane Child Health Field; Alberta Research Center for Child Health Evidence; University of Alberta, Canada; Spanish Society of Dermato-Epidemiology and Evidence-based Dermatology; and the Clínica Plató, Fundació Privada of Barcelona.
	Disclosure: Professor Bennett is the proprietor of Systematic Research Ltd and derives an income from her work as a freelance researcher. She was paid for her contributions to this review by the Cochrane Skin Group. In addition, she holds an honorary chair at Coventry University, but this does not constitute a competing interest. Drs Chen, Jiang, Yang, González, Lin, Hua, Xue, and Zhang have no conflicts of interest to declare.
	This article is an abridged version of a Cochrane Systematic Review that was published in the Cochrane Library 2016, issue 5, doi: 10.1002/14651858.CD004685.pub3. (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review.