Efficacy

Two RCTs have compared itraconazole with other oral antifungals (Table 34.1).

Versus griseofulvin

A double-blind RCT of 35 patients mostly infected with M. canis, compared 6 weeks' itraconazole, 100 mg/day, with 6 weeks' griseofulvin, 500 mg/day.22 At the 14-week follow up they showed the same complete cure rate -88%.

Versus terbinafine

A double-blind RCT of 60 patients with predominantly T. violaceum tinea capitis compared 2 weeks' itraconazole with 2 weeks' terbinafine.32 After 2 weeks the complete cure rates in the two groups differed little: 86% in the itraconazole group versus 78% in the terbinafine group.

A non-randomised trial39 compared 15 children (9 with M. canis and 6 with T. violaceum infections) treated with 50 mg itraconazole versus 56 children (38 with M. canis, 18 with other Trichophyton and Microsporum spp. infections) treated with 100 mg itraconazole orally, as capsules, once daily for a minimum of 4 and a maximum of 8 weeks. Two months after the final dose the mycological cure rates were 60% in the of 50 mg group and 89% in the 100 mg group.

I found nine uncontrolled studies, with more than 10 patients, conducted with different therapeutic regimens of itraconazole.40-48 Some studies used continuous treatment (50-100 mg/day or 5 mg/kg/day for 3-11 weeks) with capsules4042 46-48 or oral solution41 and others used pulse therapy (3-5 mg/kg/day for 1 week a month with a maximum of 3-5 pulses) with capsules43,45 or oral solution.44 Complete cure rates ranged from 81% to 100%; causative fungi were T. tonsurans and M. canis. One study46 found a complete cure rate of only 40% in children infected with T. tonsurans.

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