Meta-analysis of randomized, controlled trials comparing griseofulvin and terbinafine in the treatment of tinea capitis - 10/08/11
, Andy Soon Leong Tan, MPH b, Yuin Chew Chan, MRCP (UK) c
Reprint requests: Hong Liang Tey, MRCP (UK), National Skin Center, 1, Mandalay Road, Singapore 308205, Republic of Singapore.Abstract |
Background |
Griseofulvin has been the standard treatment for tinea capitis but newer antifungal agents, particularly terbinafine, are increasingly being used because of their shorter duration of treatment and more consistent absorption rates.
Objective |
We sought to compare the efficacy of oral griseofulvin and oral terbinafine in the treatment of tinea capitis.
Methods |
A search of MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, and the Cochrane Skin Group Ongoing Skin Trials Register was performed up to January 2010 for randomized controlled trials comparing griseofulvin and terbinafine in the treatment of tinea capitis in immunocompetent patients. The primary outcome measure was the complete cure rate. The mycological and clinical cure rates and adverse effects were secondary outcome measures. Pooling of treatment effect was accomplished using a random effects model and the I2 test was used to check for heterogeneity among the studies.
Results |
Seven studies involving 2163 subjects were included. There was no significant difference in efficacy between griseofulvin (mean duration of treatment 8 weeks, range 6-12 weeks) and terbinafine (mean duration of treatment 4 weeks, range 2-6 weeks); odds ratio = 1.22 favoring terbinafine (95% confidence interval [CI] = 0.785-1.919; P = .37). In the pooled analysis of 5 studies in which Trichophyton species were the predominant (≥65%) pathogenic dermatophyte, terbinafine showed a trend toward greater efficacy (odds ratio 1.49; 95% CI = 0.975-2.277; P = .065). Subgroup analysis revealed that terbinafine was more efficacious than griseofulvin in treating Trichophyton species (1.616; 95% CI = 1.274-2.051; P < .001) and griseofulvin was more efficacious than terbinafine in treating Microsporum species (0.408; 95% CI = 0.254-0.656; P < .001). Both griseofulvin and terbinafine demonstrated good safety profiles in the studies.
Limitations |
Data on efficacy of griseofulvin and terbinafine for separate groups of Trichophyton and Microsporum species were not available from every study. In the subgroup analysis of Microsporum species, data from only 3 studies were available.
Conclusion |
This meta-analysis suggests that terbinafine is more efficacious than griseofulvin in treating tinea capitis caused by Trichophyton species, whereas griseofulvin is more efficacious than terbinafine in treating tinea capitis caused by Microsporum species.
Le texte complet de cet article est disponible en PDF.Key words : antifungal, griseofulvin, Microsporum, systemic, terbinafine, tinea capitis, Trichophyton
Abbreviations used : CI, OR, RCT
Plan
| Funding sources: None. |
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| Conflicts of interest: None declared. |
Vol 64 - N° 4
P. 663-670 - avril 2011 Retour au numéro
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