What is the recommended treatment for tinea capitis?

From the Guidelines

The recommended treatment for tinea capitis is oral antifungal therapy, with griseofulvin and terbinafine being the most widely used first-line treatments, as they have good evidence of efficacy 1. The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology, with terbinafine being more efficacious against Trichophyton species and griseofulvin more effective against Microsporum species 1. Some key points to consider when treating tinea capitis include:

• Griseofulvin dose by body weight: < 50 kg, 15–20 mg kg−1 per day for 6–8 weeks; > 50 kg, 1 g per day for 6–8 weeks 1
• Terbinafine dose by body weight: < 20 kg, 62.5 mg per day for 2–4 weeks; 20–40 kg, 125 mg per day for 2–4 weeks; > 40 kg, 250 mg per day for 2–4 weeks 1
• Treatment should continue until clinical and mycological cure is achieved, with repeat mycology sampling recommended until mycological clearance is achieved 1
• Adjunctive therapy with antifungal shampoos can help reduce spore shedding and prevent transmission, and family members should be screened for infection 1
• Oral therapy is necessary because topical treatments alone cannot penetrate the hair shaft to reach the fungal infection in the hair follicle 1

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Accurate diagnosis of the infecting organism is essential. ... Representative treatment periods are tinea capitis, 4 to 6 weeks; 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). Adults: 0. 5 g daily (125 mg four times a day, 250 mg twice a day, or 500 mg/day).

The recommended treatment for tinea capitis is griseofulvin (PO), with a treatment period of 4 to 6 weeks. The dosage is:

• Adults: 0.5 g daily
• Pediatric patients (older than 2 years): 10 mg/kg daily, with the following dose ranges:
  • 30 to 50 lbs: 125 mg to 250 mg daily
  • over 50 lbs: 250 mg to 500 mg daily, in divided doses 2

From the Research

Tinea Capitis Treatment Options

• The recommended treatment for tinea capitis includes oral antifungal agents such as griseofulvin, terbinafine, itraconazole, and fluconazole 3, 4, 5, 6, 7.
• Griseofulvin is considered the first-line therapy for tinea capitis, with a recommended dose of 11 mg/kg per day microsize formulation for use in children 3.
• However, the efficacy of griseofulvin has been decreasing due to diverse selective pressures, requiring higher doses and longer courses of treatment 3.
• Terbinafine, itraconazole, and fluconazole have shown promise as alternative treatment options, with shorter treatment durations and comparable efficacy to griseofulvin 4, 5, 6, 7.
• A study comparing terbinafine and griseofulvin found that terbinafine was significantly better than griseofulvin for all cure rates among patients with Trichophyton tonsurans, but not Microsporum canis 5.
• Another study found that griseofulvin given for 6 weeks is similar in efficacy to terbinafine, itraconazole, and fluconazole given for 2-3 weeks for the treatment of tinea capitis caused by Trichophyton species 6.
• A randomized comparison of 4 weeks of terbinafine vs. 8 weeks of griseofulvin found that the two treatments had similar efficacy and tolerability, with terbinafine resulting in a trend to more rapid clearance of tinea capitis 7.

Treatment Duration and Efficacy

• The treatment duration for tinea capitis varies depending on the antifungal agent used, with griseofulvin typically given for 6-8 weeks and terbinafine, itraconazole, and fluconazole given for 2-6 weeks 3, 4, 5, 6, 7.
• The efficacy of treatment is influenced by the causative organism, with Trichophyton tonsurans and Microsporum canis being the most common pathogens 4, 5, 6.
• Adjunctive topical therapies, such as 2% ketoconazole and 1% selenium sulfide shampoos, may be recommended to enhance treatment efficacy 4.

Safety and Tolerability

• The safety and tolerability of antifungal agents used to treat tinea capitis are generally good, with few adverse events reported 3, 5, 6, 7.
• Griseofulvin has been associated with gastrointestinal effects, such as nausea and vomiting, in some patients 6.
• Terbinafine, itraconazole, and fluconazole have been found to have a favorable adverse-effects profile, with few reported adverse events 4, 5, 6, 7.