Treatment of otomycosis with clotrimazole: results accordingly with the fungus isolated

Abstract

Background

Otomycosis is usually caused by Candida spp or Aspergillus spp. While Candida is usually multissensitive to available antifungals, Aspergillus is not. Topical antifungals for otomycosis that are available in Portugal are scarce, and systemic treatments have too many interactions and contraindications.

Objectives

Determine otomycosis epidemiology, microbiology and treatment results.

Methods

Observational study that included patients followed in Professor Doutor Fernando Fonseca Hospital, between 2011 and 2020. Otomycosis diagnosis was obtained through ear drainage culture, and every case was treated with 1% clotrimazole ear drops plus ear cleaning once per week.

Results

Aspergillus was found in ear drainage culture in 43.9% of patients and Candida in the remaining. There was a significant statistical difference between patients with otomycosis caused by Aspergillus versus Candida in treatment duration from 25.0 days (16.5–43.0) versus 14.0 days (7.0–18.5) (p < .001), respectively.

Conclusions

Otomycosis was more frequently caused by Candida, and this type of otomycosis is treated faster with clotrimazole 10 mg/dL plus ear cleaning, when compared with otomycosis by Aspergillus.

Significance

If otomycosis causative agent is identified or suspected, a prediction of the time needed till the resolution of otomycosis can be made, when clotrimazole ear drops are used.

Chinese Abstract

背景：耳霉菌病通常由念珠菌属种或曲霉属种引起。虽然念珠菌属种通常对可得到的抗真菌剂具有多重敏感性, 而曲霉属则不是。葡萄牙可用于耳真菌病治疗的局部抗真菌药稀缺, 而全身治疗具有过多的相互作用和禁忌症。

目的：确定耳霉菌病的流行病学特征、微生物学特征和治疗结果。

方法：这是一项观察性研究, 纳入2011年至2020年在 Professor Doutor Fernando Fonseca 医院接受随访的患者。根据耳部引流培养诊断耳霉菌病, 每例均给予克霉唑滴耳剂10 mg/dL, 并每周洗耳1次。

结果：43.9%的患者在耳引流培养中发现曲霉菌, 其余为念珠菌。由曲霉菌引起的耳真菌病患者和由念珠菌引起的耳真菌病患者的治疗时间分别为 25.0 天 (16.5–43.0) 和 14.0 天 (7.0–18.5), 两者之间存在显著的统计学差异(p< .001)。

结论：耳真菌病多由念珠菌引起。该类型的耳真菌病为与曲霉菌引起的耳真菌病相比, 用克霉唑 10 mg/dL 加洗耳治疗见效更快。

意义：如果发现或怀疑耳真菌病病原体, 当使用1%克霉唑滴耳液时, 需要预测耳真菌病痊愈所需时间。

Keywords:

• Aspergillus
• Candida
• Clotrimazole
• Otomycosis

Disclosure statement

All authors declare that they have no conflict of interest.