The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment).
A Cochrane review [Abstract] 1 included 25 studies with a total of 4 449 subjects, mostly between 2 and 16 years of age.
Terbinafine for 4 weeks and griseofulvin for 8 weeks showed similar efficacy for the primary outcome of complete (clinical and mycological) cure in Trichophyton species infections (RR 1.06, 95% CI 0.98 to 1.15; 3 studies, n=328).This was also the case for mixed Trichophyton and Microsporum infections (2 studies) and in a single study analysis of Microsporum infections. Terbinafine and griseofulvin for 6 weeks showed similar efficacy (RR 1.18, 95% CI 0.74 to 1.88; 1 study, n=1 006) in children infected with Trichophyton. Sub-group analysis assessing response to treatment in children infected with T. tonsurans revealed that terbinafine was better than griseofulvin. For children infected with T. violaceum, these two regimens had similar effects. In children with Microsporum infections, a meta-analysis found that the complete cure was lower for terbinafine (6 weeks) than for griseofulvin (6-12 weeks) (RR 0.68, 95% CI 0.53 to 0.86; 2 studies, n=334). Adverse events and severe adverse events were comparable between terbinafine and griseofulvin, the adverse events being mild and reversible in most cases (RR 1.11, 95% CI 0.79 to 1.57; 1 study, n=1 549). A meta-analysis indicated that a 4-week treatment duration of terbinafine was significantly better than 1 or 2 weeks of treatment with respect to complete cure of Trichophyton and Microsporum infections (RR 0.73, 95% CI 0.62 to 0.86; 4 studies, n=552).
A meta-analysis found no significant difference between itraconazole (2 to 6 weeks) and griseofulvin (6 weeks) for achieving a complete cure in children with Trichophyton and Microsporum (RR 0.92, 95% CI 0.81 to 1.05; 2 studies, n=134). There was no difference between itraconazole and terbinafine for 2 to 3 weeks treatment (RR 0.93, 95% CI 0.72 to 1.19; 2 studies, n=160) in children infected with Trichophyton.
Results for ketoconazole versus griseofulvin in children infected with Trichophyton were limited. One study favoured griseofulvin (12 weeks) because ketoconazole (12 weeks) appeared less effective for complete cure (RR 0.76, 95% CI 0.62 to 0.94; 1 study, n=62). However, their effects appeared to be similar when the treatment lasted 26 weeks (RR 0.95, 95% CI 0.83 to 1.07). Another study indicated that complete cure was similar for ketoconazole (12 weeks) and griseofulvin (12 weeks) (RR 0.89, 95% CI 0.57 to 1.39; 1 study, n=79).
There was a similar proportion achieving complete cure with 2 to 4 weeks of fluconazole or 6 weeks of griseofulvin (RR 0.92, 95% CI 0.81 to 1.05; 3 studies, n=615).There was no significant difference for complete cure between fluconazole (for 2 to 3 weeks) and terbinafine (for 2 to 3 weeks) (RR 0.87, 95% CI 0.75 to 1.01; 1 study, n=100) and between fluconazole (for 2 to 3 weeks) and itraconazole (for 2 to 3 weeks) (RR 1.00, 95% CI 0.83 to 1.20; 1 study, n=100) in children infected with Trichophyton. 3 weeks of fluconazole was similar to 6 weeks of fluconazole in participants infected with T. tonsurans and M. canis.
Adverse events for terbinafine, griseofulvin, itraconazole, ketoconazole, and fluconazole were all mild and reversible.
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