Systemic antifungal therapy for tinea capitis in children.


BACKGROUND:Tinea capitis is a common contagious fungal infection of the scalp in children. Systemic therapy is required for treatment and to prevent spread. This is an update of the original Cochrane review. OBJECTIVES:To assess the effects of systemic antifungal drugs for tinea capitis in children. SEARCH METHODS:We updated our searches of the following databases to November 2015: the Cochrane Skin Group Specialised Register, CENTRAL (2015, Issue 10), MEDLINE (from 1946), EMBASE (from 1974), LILACS (from 1982), and CINAHL (from 1981). We searched five trial registers and checked the reference lists of studies for references to relevant randomised controlled trials (RCTs). We obtained unpublished, ongoing trials and grey literature via correspondence with experts in the field and from pharmaceutical companies. SELECTION CRITERIA:RCTs of systemic antifungal therapy in children with normal immunity under the age of 18 with tinea capitis confirmed by microscopy, growth of fungi (dermatophytes) in culture or both. DATA COLLECTION AND ANALYSIS:We used standard methodological procedures expected by Cochrane. MAIN RESULTS:We included 25 studies (N = 4449); 4 studies (N = 2637) were new to this update.Terbinafine for four weeks and griseofulvin for eight weeks showed similar efficacy for the primary outcome of complete (i.e. clinical and mycological) cure in three studies involving 328 participants with Trichophyton species infections (84.2% versus 79.0%; risk ratio (RR) 1.06, 95% confidence interval (CI) 0.98 to 1.15; low quality evidence).Complete cure with itraconazole (two to six weeks) and griseofulvin (six weeks) was similar in two studies (83.6% versus 91.0%; RR 0.92, 95% CI 0.81 to 1.05; N = 134; very low quality evidence). In two studies, there was no difference between itraconazole and terbinafine for two to three weeks treatment (73.8% versus 78.8%; RR 0.93, 95% CI 0.72 to 1.19; N = 160; low quality evidence). In three studies, there was a similar proportion achieving complete cured with two to four weeks of fluconazole or six weeks of griseofulvin (41.4% versus 52.7%; RR 0.92, 95% CI 0.81 to 1.05; N = 615; moderate quality evidence). Current evidence for ketoconazole versus griseofulvin was 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; low quality evidence). However, their effects appeared to be similar when the treatment lasted 26 weeks (RR 0.95, 95% CI 0.83 to 1.07; low quality evidence). 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; low quality evidence). For one trial, there was no significant difference for complete cure between fluconazole (for two to three weeks) and terbinafine (for two to three weeks) (82.0% versus 94.0%; RR 0.87, 95% CI 0.75 to 1.01; N = 100; low quality evidence). For complete cure, we did not find a significant difference between fluconazole (for two to three weeks) and itraconazole (for two to three weeks) (82.0% versus 82.0%; RR 1.00, 95% CI 0.83 to 1.20; low quality evidence).This update provides new data: in children with Microsporum infections, a meta-analysis of two studies found that the complete cure was lower for terbinafine (6 weeks) than for griseofulvin (6-12 weeks) (34.7% versus 50.9%; RR 0.68, 95% CI 0.53 to 0.86; N = 334; moderate quality evidence). In the original review, there was no significant difference in complete cure between terbinafine (four weeks) and griseofulvin (eight weeks) in children with Microsporum infections in one small study (27.2% versus 60.0%; RR 0.45, 95% CI 0.15 to 1.35; N = 21; low quality evidence).One study provides new evidence that terbinafine and griseofulvin for six weeks show similar efficacy (49.5% versus 37.8%; RR 1.18, 95% CI 0.74 to 1.88; N = 1006; low quality evidence). However, in children infected with T. tonsurans, terbinafine was better than griseofulvin (52.1% versus 35.4%; RR 1.47, 95% CI 1.22 to 1.77; moderate quality evidence). For children infected with T. violaceum, these two regimens have similar effects (41.3% versus 45.1%; RR 0.91, 95% CI 0.68 to 1.24; low quality evidence). Additionally, three weeks of fluconazole was similar to six weeks of fluconazole in one study in 491 participants infected with T. tonsurans and M. canis (30.2% versus 34.1%; RR 0.88, 95% CI 0.68 to 1.14; low quality evidence).The frequency of adverse events attributed to the study drugs was similar for terbinafine and griseofulvin (9.2% versus 8.3%; RR 1.11, 95% CI 0.79 to 1.57; moderate quality evidence), and severe adverse events were rare (0.6% versus 0.6%; RR 0.97, 95% CI 0.24 to 3.88; moderate quality evidence). Adverse events for terbinafine, griseofulvin, itraconazole, ketoconazole, and fluconazole were all mild and reversible.All of the included studies were at either high or unclear risk of bias in at least one domain. Using GRADE to rate the overall quality of the evidence, lower quality evidence resulted in lower confidence in the estimate of effect. AUTHORS' CONCLUSIONS:Newer treatments including terbinafine, itraconazole and fluconazole are at least similar to griseofulvin in children with tinea capitis caused by Trichophyton species. Limited evidence suggests that terbinafine, itraconazole and fluconazole have similar effects, whereas ketoconazole may be less effective than griseofulvin in children infected with Trichophyton. With some interventions the proportion achieving complete clinical cure was in excess of 90% (e.g. one study of terbinafine or griseofulvin for Trichophyton infections), but in many of the comparisons tested, the proportion cured was much lower.New evidence from this update suggests that terbinafine is more effective than griseofulvin in children with T. tonsurans infection.However, in children with Microsporum infections, new evidence suggests that the effect of griseofulvin is better than terbinafine. We did not find any evidence to support a difference in terms of adherence between four weeks of terbinafine versus eight weeks of griseofulvin. Not all treatments for tinea capitis are available in paediatric formulations but all have reasonable safety profiles.


Chen X,Jiang X,Yang M,González U,Lin X,Hua X,Xue S,Zhang M,Bennett C




Has Abstract


2016-05-12 00:00:00








  • EEG for children with complex febrile seizures.

    abstract:BACKGROUND:Febrile seizures can be classified as simple or complex. Complex febrile seizures are associated with fever that lasts longer than 15 minutes, occur more than once within 24 hours and are confined to one side of the child's body. It is common in some countries for doctors to recommend an electroencephalograp...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Shah PB,James S,Elayaraja S

    更新日期:2014-01-24 00:00:00

  • Interventions for chronic abacterial prostatitis.

    abstract:BACKGROUND:Chronic abacterial prostatitis is a common disabling but enigmatic condition with a symptom complex of pelvic area pain and lower urinary tract symptoms. The scope of treatments recommended for chronic abacterial prostatitis is a testament to how little is known about what causes the condition and how to tre...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: McNaughton C,Mac Donald R,Wilt T

    更新日期:2001-01-01 00:00:00

  • Antenatal perineal massage for reducing perineal trauma.

    abstract:BACKGROUND:Perineal trauma following vaginal birth can be associated with significant short- and long-term morbidity. Antenatal perineal massage has been proposed as one method of decreasing the incidence of perineal trauma. OBJECTIVES:To assess the effect of antenatal perineal massage on the incidence of perineal tra...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Beckmann MM,Garrett AJ

    更新日期:2006-01-25 00:00:00

  • Radiofrequency thermal ablation versus other interventions for hepatocellular carcinoma.

    abstract:BACKGROUND:Hepatocellular carcinoma (HCC) is one of the most common malignant diseases worldwide. The only possibly curative therapeutic option is surgical resection. Due to impaired liver function and/or anatomical reasons only a low percentage of patients can be treated surgically. For the remainder, several non-surg...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Galandi D,Antes G

    更新日期:2002-01-01 00:00:00

  • Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults.

    abstract:BACKGROUND:The measurement of severity and control of asthma in both children and adults can be based on subjective or objective measures. It has been advocated that fractional exhaled nitric oxide (FeNO) can be used to monitor airway inflammation as it correlates with some markers of asthma. Interventions for asthma t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Petsky HL,Cates CJ,Li A,Kynaston JA,Turner C,Chang AB

    更新日期:2009-10-07 00:00:00

  • Blood pressure lowering efficacy of angiotensin receptor blockers for primary hypertension.

    abstract:BACKGROUND:Angiotensin receptor blockers (ARBs) are widely prescribed for hypertension so it is essential to determine and compare their effects on blood pressure (BP), heart rate and withdrawals due to adverse effects (WDAE). OBJECTIVES:To quantify the dose-related systolic and/or diastolic BP lowering efficacy of AR...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Heran BS,Wong MM,Heran IK,Wright JM

    更新日期:2008-10-08 00:00:00

  • Nasal decongestants for the common cold.

    abstract:BACKGROUND:The common cold is a major and recurrent cause of morbidity, on average affecting children and adults two or more times each year. Nasal congestion is its commonest symptom and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal deconges...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Taverner D,Latte J

    更新日期:2007-01-24 00:00:00

  • Artemether for severe malaria.

    abstract:BACKGROUND:In 2011 the World Health Organization (WHO) recommended parenteral artesunate in preference to quinine as first-line treatment for people with severe malaria. Prior to this recommendation, many countries, particularly in Africa, had begun to use artemether, an alternative artemisinin derivative. This review ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Esu E,Effa EE,Opie ON,Uwaoma A,Meremikwu MM

    更新日期:2014-09-11 00:00:00

  • Parenteral anticoagulation in patients with cancer who have no therapeutic or prophylactic indication for anticoagulation.

    abstract:BACKGROUND:Anticoagulation may improve survival in patients with cancer through an antitumor effect in addition to the perceived antithrombotic effect. OBJECTIVES:To evaluate the efficacy and safety of parenteral anticoagulants in patients with cancer with no therapeutic or prophylactic indication for anticoagulation....

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Akl EA,Gunukula S,Barba M,Yosuico VE,van Doormaal FF,Kuipers S,Middeldorp S,Dickinson HO,Bryant A,Schünemann H

    更新日期:2011-01-19 00:00:00

  • Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus.

    abstract:BACKGROUND:Ethnic minority groups in upper-middle-income and high-income countries tend to be socioeconomically disadvantaged and to have a higher prevalence of type 2 diabetes than is seen in the majority population. OBJECTIVES:To assess the effectiveness of culturally appropriate health education for people in ethni...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Attridge M,Creamer J,Ramsden M,Cannings-John R,Hawthorne K

    更新日期:2014-09-04 00:00:00

  • Combination formoterol and budesonide as maintenance and reliever therapy versus current best practice (including inhaled steroid maintenance), for chronic asthma in adults and children.

    abstract:BACKGROUND:Traditionally inhaled treatment for asthma has used separate preventer and reliever therapies. The combination of formoterol and budesonide in one inhaler has made possible a single inhaler for both prevention and relief of symptoms (single inhaler therapy or SiT). OBJECTIVES:To assess the efficacy and safe...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Cates CJ,Karner C

    更新日期:2013-04-30 00:00:00

  • Posture and fluids for preventing post-dural puncture headache.

    abstract:BACKGROUND:Post-dural puncture headache (PDPH) is a common complication of lumbar punctures. Several theories have identified the leakage of cerebrospinal fluid (CSF) through the hole in the dura as a cause of this side effect. Therefore, it is necessary to take preventive measures to avoid this complication. Prolonged...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Arevalo-Rodriguez I,Ciapponi A,Munoz L,Roqué i Figuls M,Bonfill Cosp X

    更新日期:2013-07-12 00:00:00

  • Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding.

    abstract:BACKGROUND:There is conflicting evidence regarding the clinical efficacy of proton pump inhibitors (PPI) initiated before endoscopy for upper gastrointestinal bleeding. OBJECTIVES:To systematically review evidence from randomised controlled trials (RCTs) of PPI treatment initiated before endoscopy for upper gastrointe...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Sreedharan A,Martin J,Leontiadis GI,Dorward S,Howden CW,Forman D,Moayyedi P

    更新日期:2010-07-07 00:00:00

  • Preoperative fasting for preventing perioperative complications in children.

    abstract:BACKGROUND:Children, like adults, are required to fast before general anaesthesia with the aim of reducing the volume and acidity of their stomach contents. It is thought that fasting reduces the risk of regurgitation and aspiration of gastric contents during surgery. Recent developments have encouraged a shift from th...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Brady M,Kinn S,O'Rourke K,Randhawa N,Stuart P

    更新日期:2005-04-18 00:00:00

  • Long-acting inhaled bronchodilators for cystic fibrosis.

    abstract:BACKGROUND:Cystic fibrosis is a life-limiting inherited condition which affects one in 2500 newborns in the UK and 70,000 children and adults worldwide. The condition is multifaceted and affects many systems in the body. The respiratory system is particularly affected due to a build up of thickened secretions and a pre...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Smith S,Edwards CT

    更新日期:2017-12-19 00:00:00

  • Carbamazepine for schizophrenia.

    abstract:BACKGROUND:Many people with schizophrenia do not achieve a satisfactory treatment response with just antipsychotic drug treatment and various adjunct medications are used to promote additional response. The antiepileptic carbamazepine is one such drug. OBJECTIVES:To evaluate the effects of carbamazepine and its deriva...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Leucht S,Kissling W,McGrath J,White P

    更新日期:2007-07-18 00:00:00

  • Laparoscopic colposuspension for urinary incontinence in women.

    abstract:BACKGROUND:Laparoscopic colposuspension was one of the first minimal access operations for treating stress urinary incontinence in women, with the presumed advantages of shorter hospital stays and quicker return to normal activities. This Cochrane Review was last updated in 2010. OBJECTIVES:To assess the effects of la...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Freites J,Stewart F,Omar MI,Mashayekhi A,Agur WI

    更新日期:2019-12-10 00:00:00

  • Cognitive behavioural therapy plus standard care versus standard care plus other psychosocial treatments for people with schizophrenia.

    abstract:BACKGROUND:Cognitive behavioural therapy (CBT) is a psychosocial treatment that aims to help individuals re-evaluate their appraisals of their experiences that can affect their level of distress and problematic behaviour. CBT is now recommended by the National Institute for Health and Care Excellence (NICE) as an add-o...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Jones C,Hacker D,Meaden A,Cormac I,Irving CB,Xia J,Zhao S,Shi C,Chen J

    更新日期:2018-11-15 00:00:00

  • Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants.

    abstract:BACKGROUND:This section is under preparation and will be included in the next issue. OBJECTIVES:To assess the effect of prophylactic intratracheal administration of natural surfactant extract in preterm newborns at risk for developing respiratory distress syndrome (RDS). SEARCH STRATEGY:Searches were made of the Oxfo...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Soll RF

    更新日期:2000-01-01 00:00:00

  • Laetrile treatment for cancer.

    abstract:BACKGROUND:Laetrile is the name for a semi-synthetic compound which is chemically related to amygdalin, a cyanogenic glycoside from the kernels of apricots and various other species of the genus Prunus. Laetrile and amygdalin are promoted under various names for the treatment of cancer although there is no evidence for...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Milazzo S,Horneber M

    更新日期:2015-04-28 00:00:00

  • Vitamin supplementation for preventing miscarriage.

    abstract:BACKGROUND:Miscarriage is a common complication of pregnancy that can be caused by a wide range of factors. Poor dietary intake of vitamins has been associated with an increased risk of miscarriage, therefore supplementing women with vitamins either prior to or in early pregnancy may help prevent miscarriage. OBJECTIV...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Balogun OO,da Silva Lopes K,Ota E,Takemoto Y,Rumbold A,Takegata M,Mori R

    更新日期:2016-05-06 00:00:00

  • Smoking cessation intervention for reducing disease activity in chronic autoimmune inflammatory joint diseases.

    abstract:BACKGROUND:Chronic inflammatory joint diseases (IJDs) affect 1% to 2% of the population in developed countries. IJDs include rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and other forms of spondyloarthritis (SpA). Tobacco smoking is considered a significant environmental risk facto...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章


    authors: Roelsgaard IK,Esbensen BA,Østergaard M,Rollefstad S,Semb AG,Christensen R,Thomsen T

    更新日期:2019-09-02 00:00:00

  • Frenotomy for tongue-tie in newborn infants.

    abstract:BACKGROUND:Tongue-tie, or ankyloglossia, is a condition whereby the lingual frenulum attaches near the tip of the tongue and may be short, tight and thick. Tongue-tie is present in 4% to 11% of newborns. Tongue-tie has been cited as a cause of poor breastfeeding and maternal nipple pain. Frenotomy, which is commonly pe...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: O'Shea JE,Foster JP,O'Donnell CP,Breathnach D,Jacobs SE,Todd DA,Davis PG

    更新日期:2017-03-11 00:00:00

  • Physical training for asthma.

    abstract:BACKGROUND:Physical training programmes have been designed for asthmatic subjects with the aim of improving physical fitness, neuromuscular coordination and self-confidence. Habitual physical activity increases physical fitness and lowers ventilation during mild and moderate exercise thereby reducing the likelihood of ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Ram FS,Robinson SM,Black PN,Picot J

    更新日期:2005-10-19 00:00:00

  • Pars plana vitrectomy versus scleral buckling for repairing simple rhegmatogenous retinal detachments.

    abstract:BACKGROUND:Rhegmatogenous retinal detachment (RRD) is a separation of neurosensory retina from the underlying retinal pigment epithelium. It is caused by retinal tears, which let fluid pass from the vitreous cavity to the subretinal space. Pars plana vitrectomy (PPV), scleral buckling surgery and pneumatic retinopexy a...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Znaor L,Medic A,Binder S,Vucinovic A,Marin Lovric J,Puljak L

    更新日期:2019-03-08 00:00:00

  • Early erythropoiesis-stimulating agents in preterm or low birth weight infants.

    abstract:BACKGROUND:Preterm infants have low plasma levels of erythropoietin (EPO), providing a rationale for the use of erythropoiesis-stimulating agents (ESAs) to prevent or treat anaemia and to provide neuro protection and protection against necrotising enterocolitis (NEC). Darbepoetin (Darbe) and EPO are currently available...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Ohlsson A,Aher SM

    更新日期:2020-02-11 00:00:00

  • Speech and language therapy versus placebo or no intervention for speech problems in Parkinson's disease.

    abstract:BACKGROUND:Parkinson's disease patients commonly suffer from speech and vocal problems including dysarthric speech, reduced loudness and loss of articulation. These symptoms increase in frequency and intensity with progression of the disease). Speech and language therapy (SLT) aims to improve the intelligibility of spe...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Herd CP,Tomlinson CL,Deane KH,Brady MC,Smith CH,Sackley CM,Clarke CE

    更新日期:2012-08-15 00:00:00

  • Smoking reduction interventions for smoking cessation.

    abstract:BACKGROUND:The standard way most people are advised to stop smoking is by quitting abruptly on a designated quit day. However, many people who smoke have tried to quit many times and may like to try an alternative method. Reducing smoking behaviour before quitting could be an alternative approach to cessation. However,...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章


    authors: Lindson N,Klemperer E,Hong B,Ordóñez-Mena JM,Aveyard P

    更新日期:2019-09-30 00:00:00

  • Antibiotics for preventing pneumonia in children with measles.

    abstract:BACKGROUND:Measles causes more than a million deaths a year, of which most are children under five years of age who die from pneumonia. OBJECTIVES:The objective of this review was to assess the effects of antibiotics given to children with measles on reducing pneumonia or mortality, and to assess whether antibiotics s...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Shann F,D'Souza RM,D'Souza R

    更新日期:2000-01-01 00:00:00

  • Individual or group antenatal education for childbirth/parenthood.

    abstract:BACKGROUND:Structured antenatal education programs for childbirth and/or parenthood are commonly recommended for pregnant women and their partners by health care professionals in many parts of the world. Such programs are usually offered to groups but may be offered to individuals. OBJECTIVES:The objective of this rev...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Gagnon AJ

    更新日期:2000-01-01 00:00:00