From the Guidelines
Oral terbinafine is the preferred first-line treatment for pediatric tinea capitis, due to its efficacy against Trichophyton species and shorter treatment duration compared to griseofulvin. The recommended dose of terbinafine is 625 mg per day for 2-4 weeks for children weighing less than 20 kg, 125 mg per day for 2-4 weeks for children weighing 20-40 kg, and 250 mg per day for 2-4 weeks for children weighing over 40 kg 1. Griseofulvin is an alternative option, dosed at 15-20 mg/kg/day for 6-8 weeks for children weighing less than 50 kg, and 1 g per day for 6-8 weeks for children weighing over 50 kg 1.
Key Considerations
- Treatment should be directed by the causative dermatophyte and/or local epidemiology 1
- Topical therapy alone is not recommended for the treatment of tinea capitis, and oral therapy is generally indicated to achieve both clinical and mycological cure 1
- All family members should be screened for infection, and treatment is justified for asymptomatic carriers with a high spore load 1
- Concurrent use of antifungal shampoo containing ketoconazole or selenium sulfide 2-3 times weekly can help reduce spore shedding and prevent spread 1
- Treatment should continue until clinical improvement is seen and fungal cultures are negative, with repeat mycology sampling recommended until mycological clearance is achieved 1
Additional Measures
- Children receiving appropriate therapy should be allowed to attend school or nursery 1
- Index cases due to T. tonsurans warrant screening of all family members and close contacts and treatment for those positive cases 1
- Patients should avoid sharing personal items like combs, hats, or pillowcases to prevent spread of the infection 1
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Pediatric patients (older than 2 years): A dosage of 10 mg/kg daily is usually adequate (pediatric patients from 30 to 50 lbs, 125 mg to 250 mg daily; pediatric patients over 50 lbs, 250 mg to 500 mg daily, in divided doses). Representative treatment periods are tinea capitis, 4 to 6 weeks;
The recommended treatment for pediatric tinea capitis is a dosage of 10 mg/kg daily of griseofulvin, with treatment lasting 4 to 6 weeks 2.
- The dosage should be individualized for each patient.
- Concomitant use of appropriate topical agents may be required.
- Clinical relapse will occur if the medication is not continued until the infecting organism is eradicated.
From the Research
Treatment Options for Pediatric Tinea Capitis
- Griseofulvin, terbinafine, itraconazole, and fluconazole are commonly used antifungal drugs for the treatment of tinea capitis 3, 4, 5, 6, 7.
- Griseofulvin is often considered the drug of choice for tinea capitis, especially for cases caused by Microsporum species 3, 5, 6.
- Terbinafine has been shown to be effective in treating tinea capitis caused by Trichophyton species, with some studies suggesting it may be as effective as griseofulvin 4, 7.
- Itraconazole and fluconazole are also effective in treating tinea capitis, but may have varying efficacy rates depending on the causative organism 4, 5, 6.
Efficacy and Safety of Treatment Options
- Griseofulvin has been shown to have cure rates of 92-96% in some studies 3, 4.
- Terbinafine has been shown to have cure rates of 84-94% in some studies 3, 4, 7.
- Itraconazole and fluconazole have been shown to have cure rates of 84-86% in some studies 4, 5.
- Adverse effects are generally rare, but may include gastrointestinal effects with griseofulvin 4.