Tinea capitis is one of the most common
infections of children. The standard treatment is
griseofulvin.
Itraconazole and
terbinafine have in large part replaced
griseofulvin in the treatment of
onychomycosis and, in addition to
fluconazole and
ketoconazole, are evolving treatments for
tinea capitis. The purpose of this review is to compare the efficacy, safety, and cost of oral
antifungal agents for
tinea capitis. Small, open-label studies of
itraconazole,
terbinafine, and
fluconazole have reported encouraging results, suggesting that these drugs may be effective alternatives to
griseofulvin; however, in large controlled studies
griseofulvin continues to exhibit greater or equal efficacy.
Ketoconazole appears to be the least efficacious. All five drugs appear relatively safe, however, only
griseofulvin has a long track record of safety, is Food and Drug Administration (FDA) approved for the treatment of
tinea capitis in children, and has the least known drug interactions.
Fluconazole is FDA approved for use in children more than 6 months of age, yet not for the treatment of
tinea capitis. Oral
griseofulvin and
terbinafine tablets are the least expensive of the
antifungal agents;
griseofulvin suspension is, however, more expensive than
fluconazole suspension. For the combined reasons of efficacy, safety, and cost, and a long track record of use, we feel oral
griseofulvin is still the present treatment of choice for
tinea capitis. Newer antifungals are currently under investigation, and their role in treating
tinea capitis in children is still being defined.