National Skin Center, Singapore, Republic of Singapore.
J Am Acad Dermatol. 2011 Apr;64(4):663-70. doi: 10.1016/j.jaad.2010.02.048. Epub 2011 Feb 18.
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.
We sought to compare the efficacy of oral griseofulvin and oral terbinafine in the treatment of tinea capitis.
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 I(2) test was used to check for heterogeneity among the studies.
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.
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.
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.
灰黄霉素一直是头癣的标准治疗药物，但由于其治疗时间更短、吸收率更稳定，新型抗真菌药物，特别是特比萘芬，越来越多地被使用。
我们旨在比较口服灰黄霉素和特比萘芬治疗头癣的疗效。
我们检索了 MEDLINE、EMBASE、Cochrane 中心对照试验注册库和 Cochrane 皮肤组正在进行的皮肤试验注册库，截至 2010 年 1 月，检索了比较免疫功能正常患者中灰黄霉素和特比萘芬治疗头癣的随机对照试验。主要结局指标为完全治愈率。次要结局指标为真菌学和临床治愈率以及不良反应。采用随机效应模型进行治疗效果的汇总，并采用 I²检验检查研究间的异质性。
纳入了 7 项涉及 2163 例受试者的研究。灰黄霉素（治疗时间平均 8 周，范围 6-12 周）和特比萘芬（治疗时间平均 4 周，范围 2-6 周）的疗效无显著差异；特比萘芬的优势比为 1.22（95%置信区间[CI]：0.785-1.919；P=0.37）。在 5 项主要为（≥65%）亲表皮癣菌属致病真菌的研究的汇总分析中，特比萘芬显示出更高的疗效趋势（优势比 1.49；95%CI：0.975-2.277；P=0.065）。亚组分析显示，特比萘芬治疗亲表皮癣菌属的疗效优于灰黄霉素（1.616；95%CI：1.274-2.051；P＜0.001），而灰黄霉素治疗小孢子菌属的疗效优于特比萘芬（0.408；95%CI：0.254-0.656；P＜0.001）。研究中，灰黄霉素和特比萘芬均显示出良好的安全性。
并非每项研究都提供了灰黄霉素和特比萘芬分别治疗亲表皮癣菌属和小孢子菌属头癣的疗效数据。在小孢子菌属的亚组分析中，只有 3 项研究提供了数据。
本荟萃分析表明，特比萘芬治疗亲表皮癣菌属所致头癣的疗效优于灰黄霉素，而灰黄霉素治疗小孢子菌属所致头癣的疗效优于特比萘芬。
