Efficacy

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I found no systematic review. I found nine RCTs comparing griseofulvin with other oral antifungals in tinea capitis (Table 34.1).

Versus ketoconazole

I found four RCTs. In two RCTs1819 where T. tonsurans was the most commonly isolated organism, griseofulvin at doses of 10-20 mg/kg/day18 and 250-500 mg/day19 were compared with ketoconazole 3-3-6-6 mg/ kg/day18 and 200 mg/day,19 for 12 and 6 weeks, respectively. There were no statistically significant differences between the mycological cure rate of the two drugs. Cure rates in the griseofulvin groups at the end of treatment were 96%18 and 57-1%.19 A small RCT20 of 47 children compared griseofulvin 350 mg/day for 6 weeks with ketoconazole 100 mg/day for 6 weeks in inflammatory tinea capitis (T. mentagrophytes and M. canis). At the end of treatment, 80% and 100% of children respectively had improved clinically, but no mycological data were reported. An RCT of unknown blinding21 done in 63 children where Trichophyton spp. predominated, compared griseofulvin 15 mg/kg/day with ketoconazole 5 mg/kg/day, each given as a single daily dose, and treatment stopped when there was complete cure or after 6 months. After 8 weeks' therapy 92% of the patients given griseofulvin had complete cure of their infection compared with only 59% of ketoconazole-treated patients. After 12 weeks 96% of griseofulvin patients were mycologically cured compared with 74% of the ketoconazole-treated group. Hair sample cultures took significantly longer to become sterile in ketoconazole-treated (median 8 weeks) than in griseofulvin-treated (4 weeks) patients.

Versus itraconazole

I found one RCT22 done in 34 children where the majority of fungal organisms were M. canis, comparing 6 weeks of ultramicrosized griseofulvin 500 mg/day and itraconazole 100 mg/day and a follow up of 14 weeks that showed a complete cure rate of 88% for the two drugs.

Versus terbinafine

I found four RCTs. A double-blind RCT23 compared 140 children from Pakistan, of whom 87 had T. violaceum tinea capitis. They were treated with either terbinafine (by weight) for 4 weeks or with griseofulvin 6-12 mg/kg/day for 8 weeks. After 12 weeks, 93% of the terbinafine group were completely cured compared with 80% of the griseofulvin group; not a significant difference. A double-blind RCT24 evaluated 50 children from Peru, 74% of whom had T. tonsurans infections. Half were treated with terbinafine according to weight, for 4 weeks plus 4 weeks with placebo; the other half received microsized griseofulvin according to weight for 8 weeks. After 8 weeks of treatment, complete cure was noted in 76% of the griseofulvin group and in 72% of terbinafine group, but 4 weeks later the complete cure rate increased to 76% in the terbinafine group but in the griseofulvin group it had fallen to 44%, a statistically significant difference. In a large RCT,25 T. tonsurans accounted for 77% of the terbinafine group and 88% of the griseofulvin group; Microsporum spp. accounted for 14% of both groups. The RCT compared 8 weeks of griseofulvin suspension 10 mg/kg/day with 4 weeks of terbinafine. Complete cure rates at week 24 were 64% with terbinafine and 67% with griseofulvin - no significant difference. However, there was a trend to better responses in Microsporum spp. infections with 8 weeks of griseofulvin than with 4 weeks of terbinafine. In another RCT26 the complete cure rate at the final follow up visit (week 12) was 74% in the group treated with 8 weeks' ultramicrosized griseofulvin, compared with 78% of the group treated with 4 weeks' terbinafine, with no significant differences between M. canis and Trichophyton spp. infections.

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