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Comparison 1 Terbinafine (4 weeks) versus griseofulvin (8 weeks); short treatment duration; 12 to 24 weeks follow‐up, Outcome 1 complete cure.
Figuras y tablas -
Analysis 1.1

Comparison 1 Terbinafine (4 weeks) versus griseofulvin (8 weeks); short treatment duration; 12 to 24 weeks follow‐up, Outcome 1 complete cure.

Comparison 2 Terbinafine (6 to12 weeks) versus griseofulvin (12 weeks) in Microsporum infections; 16 weeks follow‐up, Outcome 1 complete cure.
Figuras y tablas -
Analysis 2.1

Comparison 2 Terbinafine (6 to12 weeks) versus griseofulvin (12 weeks) in Microsporum infections; 16 weeks follow‐up, Outcome 1 complete cure.

Comparison 2 Terbinafine (6 to12 weeks) versus griseofulvin (12 weeks) in Microsporum infections; 16 weeks follow‐up, Outcome 2 clinical cure.
Figuras y tablas -
Analysis 2.2

Comparison 2 Terbinafine (6 to12 weeks) versus griseofulvin (12 weeks) in Microsporum infections; 16 weeks follow‐up, Outcome 2 clinical cure.

Comparison 3 Terbinafine for 1, 2, and 4 weeks in Trichophyton and Microsporum infections; 12 to 20 weeks follow‐up, Outcome 1 complete cure.
Figuras y tablas -
Analysis 3.1

Comparison 3 Terbinafine for 1, 2, and 4 weeks in Trichophyton and Microsporum infections; 12 to 20 weeks follow‐up, Outcome 1 complete cure.

Comparison 3 Terbinafine for 1, 2, and 4 weeks in Trichophyton and Microsporum infections; 12 to 20 weeks follow‐up, Outcome 2 clinical cure.
Figuras y tablas -
Analysis 3.2

Comparison 3 Terbinafine for 1, 2, and 4 weeks in Trichophyton and Microsporum infections; 12 to 20 weeks follow‐up, Outcome 2 clinical cure.

Comparison 4 Terbinafine (standard dose compared to double dose) in Microsporum infections; 20 weeks follow‐up, Outcome 1 complete cure.
Figuras y tablas -
Analysis 4.1

Comparison 4 Terbinafine (standard dose compared to double dose) in Microsporum infections; 20 weeks follow‐up, Outcome 1 complete cure.

Comparison 5 Itraconazole (6 and 2 weeks, respectively) versus griseofulvin (6 weeks) in Trichophyton and Microsporum infections, Outcome 1 complete cure.
Figuras y tablas -
Analysis 5.1

Comparison 5 Itraconazole (6 and 2 weeks, respectively) versus griseofulvin (6 weeks) in Trichophyton and Microsporum infections, Outcome 1 complete cure.

Comparison 6 Itraconazole versus terbinafine (both 2 weeks) in Trichophyton infections, Outcome 1 complete cure.
Figuras y tablas -
Analysis 6.1

Comparison 6 Itraconazole versus terbinafine (both 2 weeks) in Trichophyton infections, Outcome 1 complete cure.

Comparison 6 Itraconazole versus terbinafine (both 2 weeks) in Trichophyton infections, Outcome 2 clinical cure.
Figuras y tablas -
Analysis 6.2

Comparison 6 Itraconazole versus terbinafine (both 2 weeks) in Trichophyton infections, Outcome 2 clinical cure.

Comparison 7 Ketoconazole (6 weeks) versus griseofulvin (8 to 12 weeks) in Trichophyton infections; 12 weeks follow‐up, Outcome 1 complete cure.
Figuras y tablas -
Analysis 7.1

Comparison 7 Ketoconazole (6 weeks) versus griseofulvin (8 to 12 weeks) in Trichophyton infections; 12 weeks follow‐up, Outcome 1 complete cure.

Comparison 8 Fluconazole (2 and 4 weeks respectively) versus griseofulvin (6 weeks) in Trichophyton infections; 8 ‐12 weeks, Outcome 1 complete cure.
Figuras y tablas -
Analysis 8.1

Comparison 8 Fluconazole (2 and 4 weeks respectively) versus griseofulvin (6 weeks) in Trichophyton infections; 8 ‐12 weeks, Outcome 1 complete cure.

Comparison 9 Fluconazole (2 to 3 weeks) versus terbinafine (2 to3 weeks) in Trichophyton infections; 12 weeks follow‐up, Outcome 1 complete cure.
Figuras y tablas -
Analysis 9.1

Comparison 9 Fluconazole (2 to 3 weeks) versus terbinafine (2 to3 weeks) in Trichophyton infections; 12 weeks follow‐up, Outcome 1 complete cure.

Comparison 10 Fluconazole (2 to 3 weeks) versus itraconazole (2 to 3 weeks) in Trichophyton infections; 12 weeks follow‐up, Outcome 1 complete cure.
Figuras y tablas -
Analysis 10.1

Comparison 10 Fluconazole (2 to 3 weeks) versus itraconazole (2 to 3 weeks) in Trichophyton infections; 12 weeks follow‐up, Outcome 1 complete cure.

Comparison 11 Fluconazole (different doses compared: 1.5, 3 and 6 mg/kg/day) in Trichophyton infections; 4 months follow‐up, Outcome 1 complete cure.
Figuras y tablas -
Analysis 11.1

Comparison 11 Fluconazole (different doses compared: 1.5, 3 and 6 mg/kg/day) in Trichophyton infections; 4 months follow‐up, Outcome 1 complete cure.

Table 1. Quality criteria

Studies

Randomisation

Concealment

Blinded assessment

Loss to follow up

Sample size

Inclusion/exclusion

Type of fungi

Baseline

Funding

Cáceres‐Rios 2000

Unclear

Unclear

Participants, clinicians and outcome assessors blinded

One drop‐out, group not stated

No

Yes

Yes

Adequate

Not mentioned

Dastghaib 2005

Unclear

Unclear

Participants not blinded, investigators blinded.

Five participants discontinued therapy or were lost to follow up, group not stated

No

Yes

Yes

Adequate

Not mentioned

Friedlander 2002

Unclear

Unclear baseline comparability: conflict of interest: not mentioned

Participants, clinicians and outcome assessors blinded with respect to terbinafine treatment duration of each patient.

Terbinafine for 1 week group, post‐randomisation exclusions 14/56 (25%); terbinafine for 2 weeks group, post‐randomisation exclusions: 15/59 (25%); terbinafine for 4 weeks group, post‐randomisation exclusions: 12/62 (19%).

No

Yes

Yes

Adequate

Not mentioned

Fuller 2001

Adequate (computer generated)

Unclear

Participants, clinicians and outcome assessors not blinded

Griseofulvin group, post‐randomisation exclusions 37/107 (35%), later losses 0, intention to treat 0 (only 45 completed the study); terbinafine group, post‐randomisation exclusions 26/103 (25%), later losses 0, intention to treat 0 (only 50 completed the study).
We are unaware of all the reasons for the drop‐outs in any of the groups, 68% discontinued because they were unable to attend clinic visits.

Yes

Yes

Yes

Adequate

Novartis

Gan 1987

Adequate (table of random numbers)

Unclear

Not blinded

Griseofulvin group, post‐randomisation exclusions: 11/40 (28%); ketoconazole group, post‐randomisation exclusions: 6/40 (15%).

No

Yes

Yes

Adequate

Not mentioned

Gupta 2001

Unclear

Unclear

Participants not blinded, clinicians and outcome assessors blinded

Griseofulvin group, post‐randomisation exclusions: 4/50 (8%); terbinafine group, post‐randomisation exclusions: 2/50 (4%); itraconazole group, post‐randomisation exclusions: 4/50 (8%); fluconazole group, post‐randomisation exclusions: 4/50 (8%).

No

Yes

Yes

Adequate

Not mentioned

Hamm 1999

Unclear

Unclear

Participants, clinicians and outcome assessors blinded

Any drop‐out mentioned

No

Yes

Yes

Not stated
Age: We are unaware of the mean age for each group
Sex: We are unaware of the number of females and males in each group.
Duration of complaint: Not stated

Novartis

Haroon 1995

Unclear

Unclear

No mention of blinding

No drop‐out mentioned

No

Yes

Yes

Adequate

Sandoz

Haroon 1996

Unclear

Unclear

Participants, clinicians and outcome assessors blinded

No drop‐out mentioned

No

Yes

Yes

Not stated

Sandoz

Jahangir 1998

Unclear

Unclear

Participants, clinicians and outcome assessors blinded

No drop‐out mentioned

No

Yes

Yes

Adequate

Not mentioned

Kullavanijaya 1997

Unclear

Unclear

Described as single blind and open trial study but no mention of which one (participants or observers)

Seven participants were lost to follow up and were excluded, but no further information is given.

No

The inclusion criteria are poorly stated and the exclusion criteria are not mentioned

Yes

Adequate

Sandoz

Lipozencic 2002

Unclear

Unclear

Participants, clinicians and outcome assessors blinded.

Terbinafine for 6 weeks, post‐randomisation exclusions: 7/36 (19%); terbinafine for 8 weeks, post‐randomisation exclusions: 4/34 (12%); terbinafine for 10 weeks, post‐randomisation exclusion: 6/33 (18%); terbinafine for 12 weeks, post‐randomisation exclusion: 12/32 (38%); Griseofulvin group, post‐randomisation exclusions: 7/30 (23%).

Yes

Yes

Yes

Adequate

Novartis Pharma AG

López‐Gómez 1994

Unclear

Unclear

Participants, clinicians and outcome assessors blinded.

Itraconazole group, post‐randomised exclusions: 1/18 (6%); griseofulvin group, post‐randomisation: 2/17 (12%).

No

Only inclusion criteria mentioned.

Yes

Adequate

Janssen

Martínez‐Roig 1988

Adequate (computer generated random number table)

Unclear

Participants, clinicians and outcome assessors blinded

Very difficult to follow the drop‐outs as it mixes tinea corporis and tinea capitis, we do not know to which of the two groups they belong

No

No

Yes

Not stated

Laboratories Dr. Esteve

Memisoglu 1999

Unclear

Unclear

Participants, clinicians and outcome assessors blinded

Griseofulvin group, post‐randomisation exclusions: 7/39 (18%), intention to treat: 32; terbinafine group, post‐randomisation exclusions: 4/39 (10%), intention to treat: 35.

No

Yes

Yes

Adequate

Not mentioned

Rademaker 1998

Unclear

Unclear

Not blinded

No drop‐out mentioned

No

Only inclusion criteria mentioned

Yes

Not stated

Not mentioned

Solomon 1997

Unclear

Unclear

Participants not blinded, clinicians and outcome assessors blinded

Fourteen were lost to follow up, but no further information was given.

No

Yes

Yes

Not stated

Not mentioned

Talarico Filho 1998

Unclear

Unclear

Only participants blinded

Terbinafine for 1 week, post‐randomisation exclusions: 6/42 (14%); terbinafine for 2 weeks, post‐randomisation exclusion: 6/44 (14%); terbinafine for 4 weeks, post‐randomisation exclusions: 12/46 (26%).

No

Yes

Yes

Adequate

Sandoz

Tanz 1985

Unclear

Unclear

Participants, clinicians and outcome assessors blinded

Griseofulvin group, post‐randomisation exclusions: 3/12 (25%); ketoconazole group, post‐randomisation: 5/10 (50%).

No

Yes

Yes

Adequate

Janssen

Tanz 1988

Unclear

Unclear

Participants, clinicians and outcome assessors blinded

Griseofulvin group, post‐randomisation exclusions: 3/46 (7%), later losses: 17; ketoconazole group, post‐randomisation exclusions: 2/33 (6%), later losses: 9.

No

Yes

Yes

Adequate

Janssen

Ungpakorn 2004

Unclear

Unclear

Participants, clinicians and outcome assessors blinded

Any drop‐out mentioned

Yes

Yes

Yes

Adequate

Institute of Dermatology Research Funds and Novartis (Thailand)

Figuras y tablas -
Table 1. Quality criteria
Comparison 1. Terbinafine (4 weeks) versus griseofulvin (8 weeks); short treatment duration; 12 to 24 weeks follow‐up

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 complete cure Show forest plot

5

539

Risk Ratio (M‐H, Random, 95% CI)

1.11 [0.96, 1.29]

1.1 Trichophyton infections

3

382

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.95, 1.26]

1.2 Microsporum infections

1

29

Risk Ratio (M‐H, Random, 95% CI)

0.64 [0.19, 2.20]

1.3 Mixed Trichophyton/Microsporum infections

2

128

Risk Ratio (M‐H, Random, 95% CI)

1.24 [0.64, 2.42]

Figuras y tablas -
Comparison 1. Terbinafine (4 weeks) versus griseofulvin (8 weeks); short treatment duration; 12 to 24 weeks follow‐up
Comparison 2. Terbinafine (6 to12 weeks) versus griseofulvin (12 weeks) in Microsporum infections; 16 weeks follow‐up

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 complete cure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 medium terbinafine treatment duration (6 to 8 weeks)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 long terbinafine treatment duration (10 to 12 weeks)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 clinical cure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 medium terbinafine treatment duration (6 to 8 weeks)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 long terbinafine treatment duration (10 to 12 weeks)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 2. Terbinafine (6 to12 weeks) versus griseofulvin (12 weeks) in Microsporum infections; 16 weeks follow‐up
Comparison 3. Terbinafine for 1, 2, and 4 weeks in Trichophyton and Microsporum infections; 12 to 20 weeks follow‐up

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 complete cure Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 1 week versus 2 weeks

4

360

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.66, 1.01]

1.2 1 week versus 4 weeks

4

370

Risk Ratio (M‐H, Random, 95% CI)

0.67 [0.55, 0.81]

1.3 2 weeks versus 4 weeks

4

374

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.68, 0.96]

1.4 6 weeks versus 8 weeks

1

70

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.60, 1.49]

1.5 6 weeks versus 10 weeks

1

69

Risk Ratio (M‐H, Random, 95% CI)

1.27 [0.74, 2.17]

1.6 6 weeks versus 12 weeks

1

68

Risk Ratio (M‐H, Random, 95% CI)

1.6 [0.87, 2.94]

1.7 8 weeks versus 10 weeks

1

67

Risk Ratio (M‐H, Random, 95% CI)

1.34 [0.79, 2.28]

1.8 8 weeks versus 12 weeks

1

66

Risk Ratio (M‐H, Random, 95% CI)

1.69 [0.93, 3.10]

1.9 10 weeks versus 12 weeks

1

65

Risk Ratio (M‐H, Random, 95% CI)

1.26 [0.65, 2.45]

2 clinical cure Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 1 week versus 2 weeks

3

305

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.83, 1.11]

2.2 1 week versus 4 weeks

3

316

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.63, 1.07]

2.3 2 weeks versus 4 weeks

3

319

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.72, 1.07]

2.4 6 weeks versus 8 weeks

1

70

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.62, 1.22]

2.5 6 weeks versus 10 weeks

1

69

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.69, 1.47]

2.6 6 weeks versus 12 weeks

1

68

Risk Ratio (M‐H, Random, 95% CI)

1.22 [0.79, 1.89]

2.7 8 weeks versus 10 weeks

1

67

Risk Ratio (M‐H, Random, 95% CI)

1.16 [0.82, 1.65]

2.8 8 weeks versus 12 weeks

1

66

Risk Ratio (M‐H, Random, 95% CI)

1.41 [0.94, 2.12]

2.9 10 weeks versus 12 weeks

1

65

Risk Ratio (M‐H, Random, 95% CI)

1.21 [0.78, 1.89]

Figuras y tablas -
Comparison 3. Terbinafine for 1, 2, and 4 weeks in Trichophyton and Microsporum infections; 12 to 20 weeks follow‐up
Comparison 4. Terbinafine (standard dose compared to double dose) in Microsporum infections; 20 weeks follow‐up

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 complete cure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 4. Terbinafine (standard dose compared to double dose) in Microsporum infections; 20 weeks follow‐up
Comparison 5. Itraconazole (6 and 2 weeks, respectively) versus griseofulvin (6 weeks) in Trichophyton and Microsporum infections

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 complete cure Show forest plot

2

135

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.80, 1.09]

Figuras y tablas -
Comparison 5. Itraconazole (6 and 2 weeks, respectively) versus griseofulvin (6 weeks) in Trichophyton and Microsporum infections
Comparison 6. Itraconazole versus terbinafine (both 2 weeks) in Trichophyton infections

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 complete cure Show forest plot

2

160

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.72, 1.19]

2 clinical cure Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 6. Itraconazole versus terbinafine (both 2 weeks) in Trichophyton infections
Comparison 7. Ketoconazole (6 weeks) versus griseofulvin (8 to 12 weeks) in Trichophyton infections; 12 weeks follow‐up

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 complete cure Show forest plot

2

159

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.50, 1.02]

Figuras y tablas -
Comparison 7. Ketoconazole (6 weeks) versus griseofulvin (8 to 12 weeks) in Trichophyton infections; 12 weeks follow‐up
Comparison 8. Fluconazole (2 and 4 weeks respectively) versus griseofulvin (6 weeks) in Trichophyton infections; 8 ‐12 weeks

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 complete cure Show forest plot

2

140

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.80, 1.05]

Figuras y tablas -
Comparison 8. Fluconazole (2 and 4 weeks respectively) versus griseofulvin (6 weeks) in Trichophyton infections; 8 ‐12 weeks
Comparison 9. Fluconazole (2 to 3 weeks) versus terbinafine (2 to3 weeks) in Trichophyton infections; 12 weeks follow‐up

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 complete cure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

Figuras y tablas -
Comparison 9. Fluconazole (2 to 3 weeks) versus terbinafine (2 to3 weeks) in Trichophyton infections; 12 weeks follow‐up
Comparison 10. Fluconazole (2 to 3 weeks) versus itraconazole (2 to 3 weeks) in Trichophyton infections; 12 weeks follow‐up

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 complete cure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 10. Fluconazole (2 to 3 weeks) versus itraconazole (2 to 3 weeks) in Trichophyton infections; 12 weeks follow‐up
Comparison 11. Fluconazole (different doses compared: 1.5, 3 and 6 mg/kg/day) in Trichophyton infections; 4 months follow‐up

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 complete cure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 1.5 mg versus 3 mg

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 1.5 mg versus 6 mg

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 3 mg versus 6 mg

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 11. Fluconazole (different doses compared: 1.5, 3 and 6 mg/kg/day) in Trichophyton infections; 4 months follow‐up