| Backgroud:Tinea capitis (TC),one of the most common superficial fungal diseases in the children of china, which is mostly caused as the Trichophyton species and Microsporum species. As the geographical environment, social class and medical conditions, the pathogens all the world are different, and as the changing with the time, the pathogens in the same area are changing, so the study aimed at the clinical characteristics and the distribution of pathogenic bacteria can help to provide a reference of the early diagnosis、reasonable treatment and the prevention for the dieses,which is of great importance.At present,there are so many anti-fungal drugs, such as the griseofulvin、terbinafine、itraconazole and fluconazole,as the poor effect of the topical therapy,the long drug cycle、the high price of the new antifugal drugs and the advers effects such as liver damage, at the same time, the malpractice may lead to alopecia areata, hair loss, and even cause deep fungal infection, it is important to choose a safe and effective regimen.Objective:1.To study the distribution features of pathogenic fungi of tinea capitis in Jingzhou.2.To evaluate the efficacy and safety of the terbinafine、itraconazole and fluconazole in the treatment of tinea capitis.Methods:1.To make a pathogenic identification of the children who were diagnosed as tinea capitis by fungus microscopic examination and culture from January,2015 to December,2015 in Jingzhou and make a retrospective analysis of the tinea capitis cases formly in our hospital.2. We searched the Cochrane Library, MEDLINE, EMBASE, Chinese Biological Medical Database (CBMdisc),China National Knowledge Infrastructure(CNKI), Chinese Journal Full-text Database of Science and Technology (VIP), Wan-fang Database and so on to collect the Randomized Controlled Trial (RCT) about the anti-fungal drugs of tinea capitis including griseofulvin terbinafine、itraconazole and fluconazole from the time for building these databases to December 2015.Results:1.The morbidity of tinea capitis was higest in 2006,then was a trend of fluctuation;A total 130 strains of pathogenic fungi were isolated,of these strains, the major pathogenic fungi was Trichophyton violaceum(56.92%), Trichophyton mentagrophyte(14.62%) and Trichophyton rubrum(12.31%) in turn;The 4 clinical types were black dot tinea(55.38%、tinea alba(23.08%)、tinea kerion(20.77%)and tinea favosa(0.77%).2. (1) Complete cure rate:There were no statistical significance in the complete cure rates between terbinafine and griseofulvin; other than the rates of the 4 weeks terbinafine were higher than the 1 week (RR=0.68,95%CI[0.51,0.91]),the results did not show any statistical significance in the complete cure rates in different courses of terbinafine, and the same as different dose of terbinafine、terbinafine versus itraconazole、terbinafine versus fluconazole 、itraconazole versus griseofulvin、 itraconazole versus fluconazole、fluconazole versus griseofulvin and different courses of fluconazole. (2) Mycological cure rate:There were no statistical significance in the mycological cure rates between terbinafine and griseofulvin; other than the rates of the 2 weeks (RR=0.80,95%CI[0.65,0.97]) and the 4 weeks (RR=0.76,95%CI[0.60, 0.96]) terbinafine were higher than the 1 week,the results did not show any statistical significance in the mycological cure rates in different courses of terbinafine, and the same as different dose of terbinafine、terbinafine versus itraconazole terbinafine versus fluconazole、itraconazole versus griseofulvin、itraconazole versus fluconazole、 fluconazole versus griseofulvin、different courses of fluconazole and different doses of fluconazole but than the rate of doses of 6 mg.kg-l.d-1 fluconazole higher than the 1.5 mg.kg-l.d-1(RR=0.28,95%CI[0.08,0.95]). (3)Clinical cure rate:In the Trichophyton species infections (RR=2.19,95%CI[1.31,3.64]) and mixed infections (RR=1.10, 95%CI[1.00,1.20]), the clinical cure rates of the 2-6 weeks terbinafine were higher than 6-12 weeks griseofulvin, however the Microsporum infections (RR=0.66, 95%CI[0.47,0.93]) quiet the contrary.There were no statistical significance in the clinical cure rates between terbinafine and griseofulvin; other than the rates of the 4 weeks (RR=0.66,95%CI[0.47,0.93]) terbinafine were higher than the 1 week, there were no statistical significance in the clinical cure rates in different courses of terbinafine, and the same as different courses of terbinafine 、itraconazole versus griseofulvin、itraconazole versus fluconazole、fluconazole versus griseofulvin、different courses of fluconazole. (4) Effective treatment rate:In the Microsporum infections (RR=0.67,95%CI[0.50,0.90]), the effective treatment rate of 6-12 weeks griseofulvin were higher than the 2-6 weeks terbinafine, however, there were no statistical significance in the Trichophyton species infections and mixed infections. The the effective treatment rates of the 4 weeks terbinafine were higher than 8 weeks griseofulv in the 12 weeks follow-up (RR= 1.18,95%CI[1.04,1.33]), however, there were no statistical significance in the 8 weeks follow-up, and the same as different courses and doses of terbinafine、terbinafine versus itraconazole、terbinafine versus fluconazole、itraconazole versus griseofulvin and different courses of fluconazole, in addition, the effective treatment rates of griseofulvin were higher than fluconazole (RR=0.89,95%CI[0.80,0.99]). (5) Adverse reactions:There were not any serious adverse reactions to the four anti-fungal drugs besides gastrointestinal reactions, headache, rash liver toxicity and so on. Among them, adverse reactions of the griseofulvin include:gastrointestinal reactions, headache, fever, weight gain, anemia, liver toxicity, hyperlipidemia, and lethargy, adverse reactions of the terbinafine include: gastrointestinal reactions, headache, weight gain, lethargy, urticaria, liver toxicity, hyperlipidemia, neutropenia, leucopenia, eosinophilia and pruritus, adverse reactions of the itraconazole mainly are gastrointestinal reactions, adverse reactions of the itraconazole mainly are gastrointestinal reactions,adverse reactions of the t fluconazole include:gastrointestinal reactions, headache, erythra, fever, respiratory infections, rhinitis and otitis media.Conclusion:1.The most common clinical type is black dot tinea and the pathogenic fungi is Trichophyton violaceum, so it is important for prevention and treatment to analyse the distribution features of pathogenic fungi.2.1 There is no difference in the effect between terbinafine and griseofulvin in the treatment of tinea capitis,however, the result differs in different pathogen, the clinical cure rate of terbinafine in Trichophyton species infections and mixed infections are higher than that of griseofulvin, while the different results of clinical cure rate and effective treatment rate in Microsporum infections, in addition, the adverse reactions of griseofulvin are more than terbinafine,so terbinafine prefer to be better than griseofulvin; 2.2The results are different in different courses and doses of terbinafine, the complete cure rates、 mycological cure rates and the clinical cure rates of the 4 weeks terbinafine were higher than the 1 week, the mycological cure rates of the 2 weeks terbinafine were higher than the 1 week, the longer courses and higher doses trend to be better than the shorter and lower, however, the adverse reactions are increasing at the same time, so it is better to choose the terbinafine of 2-6 weeks and standard doses; 2.3There is no difference in the efficacy and safety between terbinafine and itraconazole in the treatment of tinea capitis, however, the efficacy of terbinafine trend to be better than itraconazole; 2.4 There is no difference in the efficacy and safety between terbinafine and fluconazole in the treatment of tinea capitis, however, the efficacy of terbinafine trend to be better than fluconazole; 2.5 There is no difference in the efficacy and safety between itraconazole and griseofulvin in the treatment of tinea capitis, however, the efficacy of griseofulvin trend to be better than itraconazole, the adverse reactions of griseofulvin are more than itraconazole, so we should choose the reasonable anti-fungal drugs according to the actual situation; 2.6 There is no difference in the efficacy and safety between itraconazole and fluconazole in the treatment of tinea capitis, however, the efficacy of itraconazole trend to be better than fluconazole; 2.7 The effective treatment rates in the treatment of tinea capitis are higher of griseofulvin than fluconazole, and the same as the adverse reactions, so we should choose the reasonable anti-fungal drugs according to the actual situation; 2.8 The longer courses and higher doses of fluconazole trend to be better than the shorter and lower, however, the adverse reactions are increasing at the same time, so we should choose the reasonable courses and doses according to the actual situation. |
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