From the Guidelines
Tinea capitis in an 18-month-old child should be treated with oral griseofulvin at a dose of 15-20 mg/kg/day for 6-8 weeks, as it is the only licensed treatment for tinea capitis in children in the U.K. and has good evidence of efficacy against Microsporum species 1. The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology, and griseofulvin is more effective against Microsporum species (M. canis, M. audouinii) 1. Some key points to consider when treating tinea capitis in an 18-month-old child include:
- Oral therapy is generally indicated to achieve both clinical and mycological cure, and topical therapy alone is not recommended for the treatment of tinea capitis 1
- The dose of griseofulvin should be 15-20 mg/kg/day for 6-8 weeks, and it is essential to continue treatment for the full prescribed duration even if symptoms improve earlier, as premature discontinuation can lead to recurrence 1
- In addition to oral medication, using an antifungal shampoo containing ketoconazole or selenium sulfide 2-3 times weekly can help reduce spore shedding, and family members should be checked for infection as tinea capitis is highly contagious 1
- It is also important to note that terbinafine is an alternative treatment option, but it is not licensed for use in children under 12 years in the U.K., although it may be considered in certain circumstances 1
- The end point of treatment is mycological rather than clinical cure, and repeat mycology sampling is recommended until mycological clearance is achieved 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 Representative treatment periods are tinea capitis, 4 to 6 weeks;
The treatment for tinea capitis in an 18-month-old child cannot be determined from the provided FDA drug label because the child is younger than 2 years, and the label only provides dosage information for pediatric patients older than 2 years. 2
From the Research
Treatment Options for Tinea Capitis
The treatment for tinea capitis in an 18-month-old child typically involves systemic antifungal therapy. The following options are available:
- Griseofulvin: considered the primary antifungal agent for treating tinea capitis, especially for cases caused by Microsporum species 3
- Terbinafine: an effective alternative to griseofulvin, particularly for cases caused by Trichophyton tonsurans 4, 3
- Fluconazole: may be used as an alternative to griseofulvin, especially in cases where griseofulvin is not available or tolerated 5, 6
- Itraconazole: also considered an effective option for treating tinea capitis, although fewer clinical trials have been conducted compared to terbinafine and fluconazole 3, 6
Treatment Duration and Dosage
The treatment duration and dosage for tinea capitis vary depending on the antifungal agent used:
- Griseofulvin: typically 6-8 weeks 7
- Terbinafine: 6 weeks 4, 7
- Fluconazole: 6 weeks, although the optimal dose and duration are still being studied 5
- Itraconazole: the treatment duration and dosage are not well established for tinea capitis in children 6
Adjuvant Therapy
Topical antifungal shampoos, such as 2% ketoconazole and 1% selenium sulfide, may be used as adjuvant therapy to reduce surface colony counts of dermatophytes and prevent the spread of infection 6