Fluconazole Dosing for Children with Tinea Corporis
For children with tinea corporis, fluconazole should be dosed at 6 mg/kg daily for 2-3 weeks, with an option for once-weekly dosing at 8 mg/kg for 2-4 weeks in cases where compliance may be an issue. 1, 2, 3
Dosing Recommendations
- Fluconazole 6 mg/kg daily for 2-3 weeks is effective for treating tinea corporis in children 2
- Alternative regimen: fluconazole 8 mg/kg once weekly for 2-4 weeks, which offers similar efficacy with potentially better compliance 3
- For children weighing >50 kg, adult dosing of 150-200 mg daily or 150 mg once weekly can be used 4
- Treatment duration should be guided by clinical response, with continuation until clinical and mycological clearance is achieved 1
Age-Specific Considerations
- Fluconazole is not licensed for treatment of tinea in children <10 years in the UK, though it is licensed for children >1 year in Germany 1
- For infants under 1 year (though rarely needed for tinea corporis), dosing should be adjusted: 5
- Neonates (first 2 weeks): same dose but administered every 72 hours
- Infants 2-4 weeks: same dose but administered every 48 hours
- Infants >4 weeks: daily dosing as for older children
Efficacy and Follow-up
- Clinical studies show mycological and clinical cure rates of approximately 88% with the recommended fluconazole regimens 2
- Once-weekly dosing has demonstrated excellent efficacy with cure rates of 98% in tinea capitis (which requires longer treatment than tinea corporis) 3
- The definitive endpoint for treatment should be mycological cure, not just clinical response 1
- Consider repeating mycology sampling at the end of the standard treatment period to confirm clearance 1
Alternative Options
- If fluconazole is unavailable or contraindicated, topical antifungals are first-line for limited tinea corporis 6
- For extensive disease or treatment failures, other oral options include itraconazole (5 mg/kg/day) or terbinafine (based on weight: <20 kg: 62.5 mg/day; 20-40 kg: 125 mg/day; >40 kg: 250 mg/day) 1
Safety and Monitoring
- Fluconazole is generally well-tolerated in children with minimal adverse effects 2, 3
- Most common side effects include mild, reversible gastrointestinal complaints (reported in approximately 5% of children) 3
- Monitor for elevated liver function tests, though these are uncommon and typically asymptomatic and reversible 3
- Drug interactions to consider include enhanced toxicity with certain antihistamines, antipsychotics, anxiolytics, and statins 1
Treatment Failure Considerations
- If no clinical improvement is observed after the initial treatment course, consider: 1
- Poor compliance with medication regimen
- Suboptimal absorption of the drug
- Relative insensitivity of the causative organism
- Reinfection from family members or fomites
- In cases of clinical improvement but persistent positive mycology, continue current therapy for an additional 2 weeks 1