title: Meta-analysis of randomized, controlled trials comparing griseofulvin and terbinafine in the treatment of tinea capitis.
abstract: 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 I(2) 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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: National Skin Center, Singapore, Republic of Singapore. eyhongliang111@yahoo.com
authors.forename: Hong Liang
authors.initials: HL
authors.lastname: Tey
authors.forename: Andy Soon Leong
authors.initials: AS
authors.lastname: Tan
authors.forename: Yuin Chew
authors.initials: YC
authors.lastname: Chan
mesh_terms: D000284:Administration, Oral; D000935:Antifungal Agents / Q000627:therapeutic use*; D006118:Griseofulvin / Q000008:administration & dosage*; D006801:Humans; D009281:Naphthalenes / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D000077291:Terbinafine; D014006:Tinea Capitis / Q000188:drug therapy*
chemical_list: D000935:Antifungal Agents; D009281:Naphthalenes; D006118:Griseofulvin; D000077291:Terbinafine