Table 7.

Oral antifungals

Drug	Preparation	Indications	Adult dose	Pediatric dose	Duration	Example adverse effects	Laboratory monitoring
Griseofulvin microsize	Tablet, suspension	First-line therapy for Trichophyton tinea capitis First-line therapy for Microsporum tinea capitis Second-line therapy for refractory tinea corporis/cruris infection or with vellus hair involvement	Tinea capitisa Optimal treatment regimen unclear Tinea corporis/cruris 500–1000 mg/day	Tinea capitis 20–25 mg/kg/day Tinea corporis/cruris 10–20 mg/kg/day	6–12 weeks 2–4 weeks	Gastrointestinal distress Headache Hepatotoxicity Granulocytopenia Leukopenia	Not necessary before initiation of therapy If therapy extends past 8 weeks or multiple courses given, check liver function panel and complete blood count
Griseofulvin ultramicrosize	Tablet	First-line therapy for Trichophyton tinea capitis First-line therapy for Microsporum tinea capitis Second-line therapy for refractory tinea corporis/cruris infection or with vellus hair involvement	Tinea capitisa 10–15 mg/kg/day Tinea corporis/cruris 375–500 mg/day	Tinea capitis 10–15 mg/kg/day Tinea corporis/cruris 5–15 mg/kg/day	6–12 weeks 2–4 weeks	Gastrointestinal distress Headache Hepatotoxicity Granulocytopenia Leukopenia	Not necessary before initiation of therapy If treatment extends past 8 weeks or multiple courses given, check liver function panel and complete blood count
Terbinafine tablets	Tablet	First-line therapy for Trichophyton tinea capitis Second-line therapy for Microsporum tinea capitis First-line therapy for refractory tinea corporis/cruris infection or with vellus hair involvement First-line therapy for refractory tinea pedis	Tinea capitisa 250 mg/day Tinea corporis/cruris 250 mg/day Tinea pedis 250 mg/day	Tinea capitis 10–20 kg: 62.5 mg daily 20–40 kg: 125 mg daily ≥40 kg: 250 mg daily Tinea corporis/cruris 10–20 kg: 62.5 mg daily 20–40 kg: 125 mg daily ≥40 kg: 250 mg daily Tinea pedis 10–20 kg: 62.5 mg daily 20–40 kg: 125 mg daily ≥ 40 kg: 250 mg daily	4–6 weeks (Trichopyton); 8–12 weeks (Microsporum) 1–2 weeks 2 weeks	Gastrointestinal distress Headache Taste disturbances Hepatotoxicity Pancytopenia	Liver function panel prior to therapy initiation If treatment extends past 6 weeks, check liver function panel and complete blood count
Fluconazole	Tablet, suspension	Second-line therapy for Trichophyton tinea capitis Second-line therapy for Microsporum tinea capitis Second-line therapy for refractory tinea corporis/cruris infection or with vellus hair involvement Second-line therapy for refractory tinea pedis	Tinea capitisa 6 mg/kg/day− Tinea corporis/cruris 150–200 mg once weekly Tinea pedis 150 mg once weekly	Tinea capitis 6 mg/kg/day Tinea corporis/cruris 6 mg/kg once weekly Tinea pedis 6 mg/kg once weekly	3–6 weeks 2–4 weeks 2–6 weeks	Gastrointestinal distress Headache Hepatotoxicity Prolonged QT interval	None
Itraconazole	Capsule, solution	Second-line therapy for Trichophyton tinea capitis Second-line therapy for Microsporum tinea capitis Alternative first-line therapy for refractory tinea corporis/cruris infection or with vellus hair involvement with contraindication to terbinafine or terbinafine treatment failure Second-line therapy for refractory tinea pedis	Tinea capitisa 5 mg/kg/day Tinea corporis/cruris 200 mg/day Tinea pedis 200 mg twice daily	Tinea capitis 3–5 mg/kg/day Tinea corporis/cruris 3–5 mg/kg/day Tinea pedis 3–5 mg/kg/day	2–6 weeks 1 week (longer courses required in some cases) 1 week	Gastrointestinal distress Headache Dizziness Hepatotoxicity Cardiotoxicity (triad of hypertension, hypokalemia, peripheraledema)	Liver function panel prior to therapy initiation If treatment extends past 4 weeks, check liver function panel

^aOptimal treatment regimens for tinea capitis in adults are not well known