Post by - - S Y R K - - on Jul 9, 2007 3:57:37 GMT -5
present 9th of july...
papost sang nsg update koh. hehe.
Pediatric update: Myths disputed, traditional Tx's challenged : Three newer antifungal agents recommended against tinea capitis.
From: Dermatology Times | Date: 4/1/2002 | Author: CLARK, JENNIFER
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New Orleans -- Tinea capitis and other pediatric fungal infections may best be treated with newer drugs that provide similar cure rates as the standard therapy but are administered for half the time with fewer side effects, Sheila Fallon Friedlander, M.D., said at the annual meeting of the American Academy of Dermatology.
Dr. Friedlander presented data that was unveiled over the last year on the treatment, risk factors, and transmission of fungal infections.
"What the practitioner wants is the most effective drug that can be given for the shortest period of time with the least toxicity," she said.
With the focus on tinea capitis, she noted that the only FDA-approved treatment for children is griseofulvin (Fulvicin, Grifulvin, Grisactin). Recent data show that higher doses provide good cure rates but will increase side effects. Also, further research shows terbinafine (Lamisil), itraconazole (Sporanox), and fluconazole (Diflucan) provide similar improved cure rates but in less time with fewer adverse events.
Drug and dose of choice
Canadian researchers (Gupta AK, et al) followed 200 children in Africa and Canada with Trichophyton forms of tinea capitis. The patients were randomized to receive griseofulvin 20mg/kg for six weeks, terbinafine 250 mg/day for patients under 40 kg for two to three weeks, itraconazole 5 mg/kg/day for two to three weeks, or fluconazole 6 mg/kg/day for two to three weeks. Those patients treated with the newer antifungals were initially given two weeks of therapy, then re-evaluated at week four of the study and given another week of treatment if clinically indicated. Mycologic cure was similar between griseofulvin (92 percent) and terbinafine (94 percent), as was itraconazole (86 percent) and fluconazole (84 percent). However, only griseofulvin-treated patients reported adverse events, including six with gastrointestinal problems, and one patient discontinued therapy because of nausea.
"These data support the use of the three newer antifungal agents because they provide similar efficacy when given for one-third to one-half the time that is required for effective griseofulvin treatment. This is welcome information," said Dr. Friedlander, associate clinical professor of dermatology, Children's Hospital and University of California at San Diego Medical Center.
"However, no one else is getting cure rates that high in recently conducted studies. On the other hand, this is the best head-to-head comparative data that is available at the present time. One should keep in mind that this response to short-course therapy is limited to patients infected with Trichophyton species. Microsporum infections require much longer therapy, regardless of agent used, and it appears that griseofulvin leads to higher cure rates in this subset."
Dr. Friedlander and colleagues also followed 159 patients with Trichophyton forms of tinea capitis randomized to receive one, two, or four weeks of terbinafine, with follow-up at 12 weeks. Negative mycology cultures after treatment were noted in 60 percent, 76 percent, and 72 percent of those patients treated with one week, two weeks, and four weeks of therapy, respectively. Mycologic cure rates, which required a negative KOH as well as culture, were a bit lower but are less reliable as interpretation of KOH samples is difficult, and the viability of any organisms noted is uncertain.
"It is surprising that the cure rate was lower, though not statistically so, for longer treatment therapies. Though no real difference was found regarding duration, significant differences were found when evaluating dosing concentrations," she said.
The higher cure rates were among the patients receiving higher doses per kilogram.
The dosing regimen used in the study was a standard one used for terbinafine. Children less than 20 kg received 62.5 mg per day, while those 20 to 40 kilos received 125 mg a day. Children weighing more than 40 kilos received the standard adult dose consisting of 250 mg a day. This dosing regimen produced a fair degree of variability in dosing among the children. For example, a 20-kg child would receive 6 mg/kg/day, while a 39-kilo child would receive only 3 mg/k/day. When patients were evaluated by dosing, it was found that those receiving the higher doses fared better.
The mean treatment dose was about 4.5mg/kg/day and those with higher doses had better results. She suggests a dose of 5 to 6 mg/kg may be the most effective. The incidence of side effects was not significantly different from lower doses. The most common were GI related and there was no association between higher dosing and the risk of adverse effects.
Risk factors revisited
Dr. Friedlander also reviewed the results of a recent study investigating the importance of hair practices in the development of tinea capitis.
Researchers at Children's Mercy Hospital, Kansas City, Mo., followed 66 African American patients in three urban settings with matched controls and found no association between the infection and grooming practices, such as braiding, use of oils, or frequency of hair washing.
"We don't know why this population has a much higher incidence of tinea capitis. There has always been speculation about grooming practices, but this study failed to support that belief," Dr. Friedlander said. "One could say the study was small, but it is provocative. Most experts were surprised by these results."
Dr. Friedlander also shared some interesting findings regarding the epidemiology of tinea infections. Postmenopausal women, particularly African Americans, may develop T. tonsurans tinea capitis and probably serve as a focus for transmission of infection. These women are often caregivers to young children who may also be infected. Even the family kitten may transmit disease; in one study a brood of five infected kittens led to a small epidemic of Microsporum canis disease in almost 40 people.
Another study supports the increased risk of tinea corporis among high school wrestlers. Compared with members of the same high school track team, seven of 29 wrestlers had upper back and arm skin lesions consistent with tinea while no track team members were infected.
papost sang nsg update koh. hehe.
-----------------------------------------------------
Pediatric update: Myths disputed, traditional Tx's challenged : Three newer antifungal agents recommended against tinea capitis.
From: Dermatology Times | Date: 4/1/2002 | Author: CLARK, JENNIFER
Print Digg del.icio.us
New Orleans -- Tinea capitis and other pediatric fungal infections may best be treated with newer drugs that provide similar cure rates as the standard therapy but are administered for half the time with fewer side effects, Sheila Fallon Friedlander, M.D., said at the annual meeting of the American Academy of Dermatology.
Dr. Friedlander presented data that was unveiled over the last year on the treatment, risk factors, and transmission of fungal infections.
"What the practitioner wants is the most effective drug that can be given for the shortest period of time with the least toxicity," she said.
With the focus on tinea capitis, she noted that the only FDA-approved treatment for children is griseofulvin (Fulvicin, Grifulvin, Grisactin). Recent data show that higher doses provide good cure rates but will increase side effects. Also, further research shows terbinafine (Lamisil), itraconazole (Sporanox), and fluconazole (Diflucan) provide similar improved cure rates but in less time with fewer adverse events.
Drug and dose of choice
Canadian researchers (Gupta AK, et al) followed 200 children in Africa and Canada with Trichophyton forms of tinea capitis. The patients were randomized to receive griseofulvin 20mg/kg for six weeks, terbinafine 250 mg/day for patients under 40 kg for two to three weeks, itraconazole 5 mg/kg/day for two to three weeks, or fluconazole 6 mg/kg/day for two to three weeks. Those patients treated with the newer antifungals were initially given two weeks of therapy, then re-evaluated at week four of the study and given another week of treatment if clinically indicated. Mycologic cure was similar between griseofulvin (92 percent) and terbinafine (94 percent), as was itraconazole (86 percent) and fluconazole (84 percent). However, only griseofulvin-treated patients reported adverse events, including six with gastrointestinal problems, and one patient discontinued therapy because of nausea.
"These data support the use of the three newer antifungal agents because they provide similar efficacy when given for one-third to one-half the time that is required for effective griseofulvin treatment. This is welcome information," said Dr. Friedlander, associate clinical professor of dermatology, Children's Hospital and University of California at San Diego Medical Center.
"However, no one else is getting cure rates that high in recently conducted studies. On the other hand, this is the best head-to-head comparative data that is available at the present time. One should keep in mind that this response to short-course therapy is limited to patients infected with Trichophyton species. Microsporum infections require much longer therapy, regardless of agent used, and it appears that griseofulvin leads to higher cure rates in this subset."
Dr. Friedlander and colleagues also followed 159 patients with Trichophyton forms of tinea capitis randomized to receive one, two, or four weeks of terbinafine, with follow-up at 12 weeks. Negative mycology cultures after treatment were noted in 60 percent, 76 percent, and 72 percent of those patients treated with one week, two weeks, and four weeks of therapy, respectively. Mycologic cure rates, which required a negative KOH as well as culture, were a bit lower but are less reliable as interpretation of KOH samples is difficult, and the viability of any organisms noted is uncertain.
"It is surprising that the cure rate was lower, though not statistically so, for longer treatment therapies. Though no real difference was found regarding duration, significant differences were found when evaluating dosing concentrations," she said.
The higher cure rates were among the patients receiving higher doses per kilogram.
The dosing regimen used in the study was a standard one used for terbinafine. Children less than 20 kg received 62.5 mg per day, while those 20 to 40 kilos received 125 mg a day. Children weighing more than 40 kilos received the standard adult dose consisting of 250 mg a day. This dosing regimen produced a fair degree of variability in dosing among the children. For example, a 20-kg child would receive 6 mg/kg/day, while a 39-kilo child would receive only 3 mg/k/day. When patients were evaluated by dosing, it was found that those receiving the higher doses fared better.
The mean treatment dose was about 4.5mg/kg/day and those with higher doses had better results. She suggests a dose of 5 to 6 mg/kg may be the most effective. The incidence of side effects was not significantly different from lower doses. The most common were GI related and there was no association between higher dosing and the risk of adverse effects.
Risk factors revisited
Dr. Friedlander also reviewed the results of a recent study investigating the importance of hair practices in the development of tinea capitis.
Researchers at Children's Mercy Hospital, Kansas City, Mo., followed 66 African American patients in three urban settings with matched controls and found no association between the infection and grooming practices, such as braiding, use of oils, or frequency of hair washing.
"We don't know why this population has a much higher incidence of tinea capitis. There has always been speculation about grooming practices, but this study failed to support that belief," Dr. Friedlander said. "One could say the study was small, but it is provocative. Most experts were surprised by these results."
Dr. Friedlander also shared some interesting findings regarding the epidemiology of tinea infections. Postmenopausal women, particularly African Americans, may develop T. tonsurans tinea capitis and probably serve as a focus for transmission of infection. These women are often caregivers to young children who may also be infected. Even the family kitten may transmit disease; in one study a brood of five infected kittens led to a small epidemic of Microsporum canis disease in almost 40 people.
Another study supports the increased risk of tinea corporis among high school wrestlers. Compared with members of the same high school track team, seven of 29 wrestlers had upper back and arm skin lesions consistent with tinea while no track team members were infected.
