Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC). See guidance on dosing in children for quick reference dosage/weight guide. Refer to drug interactions table for detailed drug interactions for all antimicrobials. Note extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
Note additional warnings for clarithromycin and fluoroquinolones
Dermatophyte and other fungal infections of the skin
- Tinea (ringworm)
- Malassezia (pityriasis versicolor)
- Tinea corporis (T. rubrum/M.canis)
- Tinea capitis (scalp ringworm)
- Tinea manum (hands)
- Tinea cruris (groin/flexural areas) T.rubrum
- Tinea pedis (feet)
Avoid topical steroids--> tinea incognito
Do skin scrapings if suspicious
- Terbenafine cream should suffice.
- Oral if severe or recalcitrant disease.
- Must do a skin scraping or brushing to culture species to direct treatment.
- Terbenafine or Itraconazole
Tinea capitis (scalp ringworm)
- Itraconazole – activity against Microsporum and Trichphyton species. Fungicidal and fungistatic. Licensed in Europe for children, not in U.K.
- Dosing: 5mgs/kg 2-4 weeks
- Griseofulvin: Only licensed antifungal for children under 12 in the U.K.
- 1g in children weighing >50kgs 6-8 weeks
- 15-20mgs/kg in single or divided doses in children > 50kgs 6-8 weeks
- Terbenafine: unlicensed in children in the U.K.
- <20kgs - 62.5mgs od 2-4 weeks
- >20 kgs - 125mgs od 2-4 weeks
- >40kgs - 250mgs od for 2-4 weeks
- Recheck with skin scraping/hair pull after course of treatment until clear.
- Treat household with Ketoconazole shampoo to prevent re-infection.
- Treat asymptomatic carriers with a high spore load
- Children should not be excluded from school.
- Treatment should be prompt to avoid scarring alopecia.
- Screen all family members skin scraping/hair pull.
- Disinfect hair brushes, combs, razors. Do not share brushes to prevent spread.
- Consider 2nd line agent if treatment failure
Fuller L et al.BAD guidelines for tinea capitis 2014;171:454-463.
First line :
Ketoconazole /selenium sulphide/ or zinc pyrithione shampoo applied topically to scalp and skin for 5- 10 minutes for 1-4 weeks. 1-4 times monthly for maintenance.
Imidazole reamod 1-4 weeks
Fluconazole 300mgs /week for 2 weeks.
Resistant: second line treatments
Itraconazole (Sporonox) 200mgs od 5-7 days
Lactic acid cream/ salicylic acid shampoo.
Comments from Expert Advisory Committee
Take skin scrapings for culture if not localised.
- Treatment: 1 week terbinafine as effective as 4 weeks azole.A-
- If intractable consider oral itraconazole. Discuss scalp infections with specialist.
|Topical 1% terbinafineA+
|Topical undecenoic acid or 1% azoleA+
||4 – 6 weeksA+
We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.
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Reviewed June 2016