The Pharmaceutical Journal
Vol 279 No 7481 p641
8 December 2007

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Fluconazole reasonable alternative to griseofulvin

Fluconazole is a reasonable alternative to griseofulvin for treating scalp ringworm in children, according to the December issue of the Drug and Therapeutics Bulletin.

In an update to previous advice issued in 1996, which recommended griseofulvin, the DTB says that evidence indicates the newer antifungals — terbinafine, fluconazole and itraconazole — are as effective and as well tolerated as griseofulvin, but require shorter treatment courses.

Terbinafine is increasingly recommended as first-line treatment for the most common cause of scalp ringworm infection in the UK and is the cheapest option, says the DTB.

However, the bulletin raises concerns that it has not been licensed for children despite evidence of its effectiveness and that a suitable formulation is not available. Similarly, itraconazole is only available in 100mg capsules, making it difficult to use on a dose per weight basis, it says. In contrast, fluconazole is available as a powder for oral suspension as well as capsules and seems a reasonable alternative, it says.

The bulletin also highlights that topical antifungals are generally considered inadequate sole treatments for scalp ringworm but can be used as an adjunct to oral therapy.

The December DTB also reviews the effectiveness and safety of steroids for bacterial meningitis in children.

It concludes that it is reasonable, on current information, to give dexamethasone initially to any child older than one month presenting with bacterial meningitis who does not have a rash suggestive of meningococcal disease. This is because the infection could be due to Haemophilus influenzae b, for which there is evidence that treatment prevents hearing loss.