What is the appropriate dosing of Griseofulvin (antifungal medication) for pediatric patients?

From the Guidelines

Griseofulvin dosing for pediatric patients should be 15–20 mg kg−1 per day for those weighing less than 50 kg, and 1 g per day for those weighing more than 50 kg, given for 6–8 weeks. This recommendation is based on the British Association of Dermatologists' guidelines for the management of tinea capitis 1. The guidelines suggest that oral therapy is generally indicated to achieve both clinical and mycological cure, and griseofulvin is a first-line treatment option, particularly effective against Microsporum species 1.

Key Considerations

• The dose of griseofulvin should be adjusted based on the patient's weight, with a single or divided dose regimen 1.
• Treatment duration is typically 6–8 weeks, but may need to be extended in cases of treatment failure or ongoing positive mycology 1.
• Griseofulvin should be used with caution in patients with certain medical conditions, and drug interactions should be carefully monitored, particularly with medications such as warfarin, antihistamines, and antipsychotics 1.

Monitoring and Follow-up

• Regular monitoring of liver function is recommended for extended treatment courses 1.
• Repeat mycology sampling is recommended until mycological clearance is achieved, as the end point of treatment is mycological rather than clinical cure 1.

Alternative Treatment Options

• Terbinafine is an alternative treatment option, particularly effective against Trichophyton species, and may be preferred due to its shorter treatment protocol 1.
• Itraconazole is a second-line therapy option, safe and effective against both Trichophyton and Microsporum species 1.

From the FDA Drug Label

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).

In one study in pediatric patients 19 months to 11 years of age, 10 mg/kg of griseofulvin microsize given with milk resulted in mean peak serum concentrations approximately four-fold greater than the same griseofulvin dose given alone

The appropriate dosing of Griseofulvin for pediatric patients is 10 mg/kg daily, which can be achieved by the following dosages:

• Pediatric patients from 30 to 50 lbs: 125 mg to 250 mg daily
• Pediatric patients over 50 lbs: 250 mg to 500 mg daily It is recommended to administer the drug in divided doses and consider giving it with milk to increase absorption 2 2.

From the Research

Dosing of Griseofulvin for Pediatric Patients

• The appropriate dosing of Griseofulvin for pediatric patients is typically in the range of 10-20 mg/kg per day, with a microsize formulation being used 3, 4, 5.
• One study used a dose of 20 mg/kg/day for 6 weeks in the treatment of tinea capitis caused by Trichophyton species 3.
• Another study used a dose of 10-20 mg/kg per day for 6 weeks, with 86.7% of patients receiving a dose of 10-19.9 mg/kg per day 4.
• The Physician's Desk Reference recommends a dose of 11 mg/kg per day microsize formulation for use in children 5.

Comparison with Other Antifungal Agents

• Griseofulvin has been compared to other antifungal agents such as terbinafine, itraconazole, and fluconazole in the treatment of tinea capitis 3, 4, 5.
• Terbinafine has been shown to be an effective alternative to griseofulvin, with a dose of 5-8 mg/kg per day being used in one study 4.
• Itraconazole has been used to treat fungal infections in infants, with a dose of 5 mg/kg per day being used for superficial fungal infections and 10 mg/kg per day being used for systemic fungal infections 6.
• Fluconazole has been used to treat tinea capitis, with a dose of 6 mg/kg per day being used in one study 5.