Original article
Meta-analysis of randomized, controlled trials comparing griseofulvin and terbinafine in the treatment of tinea capitis

https://doi.org/10.1016/j.jaad.2010.02.048Get rights and content

Background

Griseofulvin has been the standard treatment for tinea capitis but newer antifungal agents, particularly terbinafine, are increasingly being used because of their shorter duration of treatment and more consistent absorption rates.

Objective

We sought to compare the efficacy of oral griseofulvin and oral terbinafine in the treatment of tinea capitis.

Methods

A search of MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, and the Cochrane Skin Group Ongoing Skin Trials Register was performed up to January 2010 for randomized controlled trials comparing griseofulvin and terbinafine in the treatment of tinea capitis in immunocompetent patients. The primary outcome measure was the complete cure rate. The mycological and clinical cure rates and adverse effects were secondary outcome measures. Pooling of treatment effect was accomplished using a random effects model and the I2 test was used to check for heterogeneity among the studies.

Results

Seven studies involving 2163 subjects were included. There was no significant difference in efficacy between griseofulvin (mean duration of treatment 8 weeks, range 6-12 weeks) and terbinafine (mean duration of treatment 4 weeks, range 2-6 weeks); odds ratio = 1.22 favoring terbinafine (95% confidence interval [CI] = 0.785-1.919; P = .37). In the pooled analysis of 5 studies in which Trichophyton species were the predominant (≥65%) pathogenic dermatophyte, terbinafine showed a trend toward greater efficacy (odds ratio 1.49; 95% CI = 0.975-2.277; P = .065). Subgroup analysis revealed that terbinafine was more efficacious than griseofulvin in treating Trichophyton species (1.616; 95% CI = 1.274-2.051; P < .001) and griseofulvin was more efficacious than terbinafine in treating Microsporum species (0.408; 95% CI = 0.254-0.656; P < .001). Both griseofulvin and terbinafine demonstrated good safety profiles in the studies.

Limitations

Data on efficacy of griseofulvin and terbinafine for separate groups of Trichophyton and Microsporum species were not available from every study. In the subgroup analysis of Microsporum species, data from only 3 studies were available.

Conclusion

This meta-analysis suggests that terbinafine is more efficacious than griseofulvin in treating tinea capitis caused by Trichophyton species, whereas griseofulvin is more efficacious than terbinafine in treating tinea capitis caused by Microsporum species.

Section snippets

Inclusion criteria

Only randomized controlled trials (RCT) were included. The subjects were immunocompetent children and adults with a diagnosis of tinea capitis confirmed by the presence of dermatophytes by direct microscopy, culture, or both.

The primary outcome measure was the complete cure rate. Complete cure is defined as the achievement of both clinical and mycological cure. The secondary outcome measures were: (1) mycological cure rate (defined as the absence of dermatophytes on direct microscopy and

Included studies

The search yielded 8 RCT comparing griseofulvin and terbinafine. One open study was excluded from the analysis because no data on the cure rates from each type of treatment were provided.3 Seven studies comparing griseofulvin and terbinafine and involving 2163 subjects were analyzed and their characteristics are listed in Table I.

In most studies, the majority of the pathogens were Trichophyton species. One study was comprised entirely of Microsporum species6 and another had similar proportions

Griseofulvin

Griseofulvin is derived from Penicillium griseofulvum. It is fungistatic, arresting mitosis at the metaphase stage of microtubule spindle formation, thereby arresting cell division and impairing fungal cell wall synthesis in actively growing fungi. Griseofulvin has been the standard of care11 and is licensed for treatment of tinea capitis in most countries. It has served as a standard for comparison with the newer antifungal agents. The advantages of griseofulvin are that it is inexpensive and

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Funding sources: None.

Conflicts of interest: None declared.

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