Trichophyton Tinea Capitis When Terbinafine Has Not Achieved Mycological Clearance
Scalp ringworm where mycology or culture has confirmed a Trichophyton species with Microsporum species not identified — and first-line oral terbinafine has failed to reach the required treatment endpoints.
As a general rule, terbinafine is more efficacious against Trichophyton species, while griseofulvin is more effective against Microsporum species. When Trichophyton is confirmed on culture but terbinafine therapy has not achieved clearance, a different oral antifungal approach is indicated.
Prior therapy: Oral terbinafine dosed by body weight
Goals not achieved: Clinical improvement of scalp lesions and mycological clearance. Because the endpoint is mycological rather than clinical cure, failure is confirmed when repeat mycology sampling remains positive.
The endpoint of treatment is mycological rather than clinical cure. Repeat mycology sampling is recommended until mycological clearance is achieved.
References
- As a general rule, terbinafine is more efficacious against Trichophyton species (T. tonsurans, T. violaceum, T. soudanense), and griseofulvin more effective against Microsporum species (M. canis, M. audouinii).
- Itraconazole is safe, effective and has activity against both Trichophyton and Microsporum species.
- Itraconazole, 50-100 mg per day for 4 weeks, or 3 mg kg⁻¹ per day for 2-4 weeks.
- The end point of treatment is mycological rather than clinical cure; therefore repeat mycology sampling is recommended until mycological clearance is achieved.