Lamisil, a potent alternative antifungal drug for otomycosis
Health Institute2015, Current Medical Mycology
Sign up for access to the world's latest research
checkGet notified about relevant papers
checkSave papers to use in your research
checkJoin the discussion with peers
checkTrack your impact
Abstract
Otomycosis is an acute, subacute or chronic fungal infection of the pinna, the external auditory meatus and the ear canal caused mainly by several species of saprophytic fungi. Lamisil (Terbinafine) is an allylamine antifungal agent, that is used both in the topical and oral administration for the treatment of dermatophytosis, cutaneous candidiasis, and the pityriasis versicolor. We investigated the in vitro activity of clotrimazole, miconazole, nystatin, and Lamisil against the agents of otomycosis. Materials and Methods: Fifteen clinically obtained isolates from otomycosis (Aspergillus species; n=13, and Candida species, n=2) and 8 environmental isolates of Aspergillus were tested. The disk diffusion method was employed to detect susceptibility. In the present study, the in vitro activity of the terbinafine with clotrimazole, miconazole, and nystatin against several isolates of Aspergillus and Candida with different sources were compared. Results: Out of 23 isolates of Aspergillus, Candida 4(17.4%) and 1(4.4%) were resistant to nystatin and miconazole, respectively. In addition, all tested organisms were sensitive to clotrimazole and terbinafine. Statistical analysis has shown that there are no significant differences on the effects of clotrimazole, miconazole and, terbinafine on saprophytic (environmental) and pathogenic isolates of A. niger, A. flavus, and A. terreus (P value= 0.85). In addition, all tested organisms were found to be highly susceptible to terbinafine (P< 0.04). Conclusion: This is a new approach for the possible use of Lamisil for the treatment of otomycosis.
Related papers
Ototopical antifungals and otomycosis: a review
International journal of pediatric …, 2008
Sertaconazole versus Clotrimazole and Miconazole Creams in the Treatment of Otomycosis: A Placebo-Controlled Clinical Trial
Iranian Journal of Otorhinolaryngology, 2022
Introduction: Fungal otitis extern or otomycosis, is common worldwide, and resistance of fungal organisms to antifungal drugs has been reported in otomycosis and other fungal infections. This study aimed to evaluate the clinical efficacy of sertaconazole versus placebo, as well as miconazole and clotrimazole topical creams in otomycosis patients. Materials and Methods: In this double-blinded clinical trial, 138 otomycosis patients (230 ears) were evaluated in four groups. After the first session of the ear canal debridement and irrigation with acetic acid 2% solution, the patients were treated with either A) sertaconazole 2% cream, B) miconazole 2% cream, C) clotrimazole 2% cream, or D) placebo. The results of clinical evaluations and response to treatment (complete, partial, and no response) were recorded at the time of the first visit and by the end of the first, second, and fourth weeks of treatment. A p-value less than 0.05 was considered statistically significant. Results: Resp...
Clinicomycological Study of Otomycosis with Antifungal Susceptibility Testing Of Fungal Isolates
IOSR Journals , 2019
Otomycosis or fungal otitis externa is a superficial, sub-acute or chronic infection of the external auditory canal, usually with unilateral presentation characterized by inflammation, pruritis, scaling and otalgia. Aim Of The Study: To find the prevalence of otomycosis along with its clinicomycologicalprofile,to explore specific predisposing factors,to isolate and identify the causative fungus and antifungal susceptibility testing for moulds by E test and for yeast by disk diffusion method. Methodology:Ear swabs were collected from 30 clinically suspected cases of otomycosis and all the samples were processed by direct microscopy of KOH mount and Gram staining. Culture was carried out on SDA.The identification process of the isolated fungus was done by standard procedures. Antifungal sensitivity of moulds was performed on RPMI 1640 agar supplemented with 2% glucose and tested for fluconazole (0.016-256 mcg/ml), Itraconazole(0.002 mcg/ml to 32 mcg/ml) and Caspofungin (0.002-32 mcg/ml) (HiMedia) by E strip .AFST for yeast was performed by the disc diffusion method on Mueller Hinton Agar supplemented with 2% glucose and 0.5mg/ L Methylene Blue (HiMedia)and tested for Fluconazole (10μg),Nystatin (100U), Amphotericin (100U), Ketoconazole (10μg) and Clotrimazole (10μg) disk (HiMedia). Result And Conclusion:Otomycosis was diagnosed in 100% of the cases with highest prevalence in 21-40 years of age group with a female preponderance.Itching was found to be the commonest symptom followed by ear pain.Ear pricking with hard objects was found to be the most common predisposing factor followed by swimming or pond bath. Seven cases were associated with tympanic membrane perforation. Of the 30 cases 32 number of fungi were isolated. Fungal isolates were predominantly mould (90.62%) while rest were yeast (9.38%). Mixed infection with more than one fungus was seen in 2 cases (6.67%). A.niger was the predominant fungus (71.88%) followed by A.flavus(18.75%) and C.tropicalis(9.37%). All the yeasts were found to be sensitive to Ketoconazole,Nystatin and Amphotericin and all moulds were found to be resistant to fluconazole.
Effectiveness of Chloroxylenol and Chlorhexidine - Cetrimide Disinfectants on Fungal Isolates from Clinically Suspected Cases of Uncomplicated Otomycosis
Journal of evolution of medical and dental sciences, 2013
BACKGROUND: Otomycosis is a superficial mycotic infection of the external auditory canal. The infection may be either subacute or chronic in nature. Otomycosis occurs worldwide but is more common in tropical and subtropical countries. Fungal agents most commonly causing otomycosis are Aspergillus niger, Candida albicans, Aspergillus flavus, Aspergillus fumigatus, Candida parapsilosis, Penicillium, Mucor, Rhizopus, Absidia and Scopuloriopsis spp. Many agents have been recommended for treating otomycosis, but no preparation has been widely accepted. Vigorous cleaning of the external auditory canal remains the mainstay in treating otomycosis, along with usage of topical anti-fungal agents. OBJECTIVE: To compare the efficacy of chloroxylenol (Dettol) and chlorhexidine-cetrimide (savlon) with 1% clotrimazole+1% lidocaine ear drops. METHODS AND MATERIALS: Agar well diffusion method was used on the isolates obtained from uncomplicated clinically diagnosed otomycosis cases. RESULTS: The isolates, Aspergillus niger, Aspergillus flavus, Candida albicans, Candida glabrata and Candida parapsilosis were susceptible to undiluted concentration of dettol and not susceptible to savlon. CONCLUSION: Dettol can be used to reduce the fungal burden in the external auditory canal, and it should be followed by topical application of clotrimazole ear drops to cure the disease.
In vitro activity of terbinafine and itraconazole against Aspergillus species isolated from otomycosis
Mycoses, 2004
The minimum inhibitory concentrations (MIC, lg ml )1 ) of itraconazole and terbinafine against overall 34 Aspergillus isolates from the external ear canals with otomycosis have been determined with M38-P microdilution method suggested by National Committee for Clinical Laboratory Standards (NCCLS). MIC intervals in 48 h determined by taking MIC-2 value of itraconazole (the lowest drug concentration causing 50% inhibition of visible fungal growth) and MIC-0 value of terbinafine (the lowest drug concentration causing 100% inhibition of visible fungal growth) as a basis have been found as follows: 0.125-1 and 0.06-0.5 lg ml )1 for A. niger (22 strains), 0.06-0.25 and 0.06-0.125 lg ml )1 for A. flavus (10 strains), 0.125 and 0.125-0.5 lg ml )1 for A. terreus (two strains). It has been observed that both of the antifungal agents showed an in vitro activity against all Aspergillus species tested.
Etiologic role of Aspergillus species in otomycosis
A study was undertaken to ascertain the etiologic role of Aspergillus species in otitis externa in 34 patients, which comprised of 20 males and 14 females of different age groups attending the outpatients department of ENT at Bharauch, Gujarat, India. The fungi were demonstrated in 26 patients, giving a prevalence of 76.4%. The diagnosis in each patient was established by direct microscopy of fungal elements in cytological smear, and by cultural isolation of fungi on Sabouraud medium and " APRM " medium. Among the various Aspergillus species , A. niger was most commonly identified (41.0%), followed by A. flavus, A. terreus, A. fumigates, A.candidua , and A.nidulans. The detailed morphology of fungal isolates was studied in " Narayan " stain. All cases of fungal otitis were unilateral. The most important predisposing factors associated with disease were mechanical injury, and use of topical antibacterial antibiotics. Topical application of 1% clotimazole, and 2% mercurochrome solution showed good clinical response in most of the patients. It is emphasized that cytological examination should be carried out in all the patients to elucidate the causative significance of opportunistic fungi in otitis externa. Moreover, " Narayan " stain should be widely employed in microbiology laboratory to study the morphology of fungi implicated in otomycosis. As mercurochrome is very cheap compound, its use in poor resource nations for the management of mycotic otitis is emphasised. The routine application of new medium " APRM " , which is very cheap, and easy to prepare, is recommended for primary isolation of opportunistic fungi from clinical and environmental materials.
A study of clinico-mycological profile and treatment of primary otomycosis
Asian Journal of Medical Sciences
Background: Otomycosis is a superficial mycotic infection of the external auditory canal. Clinical presentation, along with otoscopic findings, is sufficient to make the diagnosis in most of the cases. Treatment includes aural cleaning followed by the instillation of anti-fungal ear drops. In the recent years, there has been an increasing trend of antifungal resistance for the commonly used antifungals such as fluconazole and clotrimazole. Drug sensitivity patterns have also shown variability from one region to another. Aims and Objectives: To evaluate the clinico-mycological profile along with antifungal susceptibility pattern and treatment outcome of primary otomycosis. Materials and Methods: A total of 230 clinically diagnosed patients of primary otomycosis were included in this prospective study. Microbiological causes were evaluated by KOH wet mount and culture of samples collected from external auditory meatus using sterile swabs. Fungal culture was done on Sabouraud dextrose ...
Antifungal Susceptibility Pattern in Otomycosis among Patients Attending a Tertiary Healthcare Institution in Port Harcourt, Nigeria
Asian Journal of Medicine and Health, 2022
Antifungal resistance is one of the factors considered to hamper effective treatment of otomycosis. Consequently, this study was aimed at isolating etiological agent for otomycosis among patients that visited University of Port Harcourt Teaching Hospital from June 2017 to June 2018 and carry out antifungal susceptibility testing with the isolates. Ear swab from 120 patients and 120 control group was aseptically collected. Nystatin, voriconazole and fluconazole were used for antifungal susceptibility testing by agar diffusion method. Isolation and identification of fungal isolates was by Standard microbiological methods. From our result, fungi were isolated from ear swab of 34 patients and 5 from the control. The isolates and their frequency of occurrence are Candida sp. (61.8%), Aspergillus sp. (23.5%) and Penicillium sp. (8.8%), while Candida albicans was the only isolate seen among the control group. Susceptibility result revealed that Candida sp. and Penicillium sp. as being sens...
Effectiveness of 7.5 Percent Povidone Iodine in Comparison to 1 Percent Clotrimazole with Lignocaine in the Treatment of Otomycosis
ISRN Otolaryngology, 2013
Objectives. Otomycosis is a common ENT disease frequenting the tropics. Its recurrent nature poses a great challenge to the treating physician. In spite of a number of antifungals in the market, the frequent nature of this disease warrants repeated use of these drugs, contributing to drug resistance and financial burden on the rural population. Our primary aims were to evaluate the effectiveness of povidone iodine in the treatment of otomycosis and to identify the most common fungal isolate in our population. Study Design and Setting. A single blinded prospective longitudinal study was done over a period of 12 months in a tertiary referral center. 34 patients in the age group 15-70 years clinically diagnosed with otomycosis were included in this study. These individuals were divided into two groups selected randomly. One arm received 7.5% povidone iodine otic drops and the other 1% Clotrimazole and lignocaine drops. Evaluation was based on resolution of symptoms and signs after treatment. Result. Both arms showed improvements which were comparable thus suggesting the role of povidone iodine in the management of otomycosis. Conclusion. Povidone iodine is an effective antifungal in the treatment of otomycosis.
Fungal Profile and Its Characteristics in Patients of Otomycosis-A Prospective Study
NATIONAL JOURNAL OF LABORATORY MEDICINE
The samples were collected under aseptic conditions using sterile cotton swab from the external auditory canal. To diagnose otomycosis, detailed history, clinical examination, otoscopic findings and laboratory identification of fungus were considered [9].
Related papers
Identification of Fungal Pathogens in Otomycosis and Their Drug Sensitivity: Our Experience
International Archives of Otorhinolaryngology, 2018
Introduction Otomycosis is a common problem in otolaryngology practice. However, we usually encounter some difficulties in its treatment because many patients show resistance to antifungal agents, and present high recurrence rate. Objectives To determine the fungal pathogens that cause otomycosis as well as their susceptibility to the commonly used antifungal agents. Additionally, to discover the main reasons for antifungal resistance. Methods We conducted an experimental descriptive study on 122 patients clinically diagnosed with otomycosis from April 2016 to April 2017. Aural discharge specimens were collected for direct microscopic examination and fungal culture. In vitro antifungal susceptibility testing was performed against the commonly used antifungal drugs. We tested the isolated fungi for their enzymatic activity. Results Positive fungal infection was found in 102 samples. The most common fungal pathogens were Aspergillus and Candida species, with Aspergillus niger being th...
Isolation, Characterization, and Antifungal Sensitivity Pattern of Candida Species Causing Otomycosis
Acta Medica Iranica., 2024
Otomycosis is one of the overwhelming diseases both for patients and specialists with a high recurrence rate despite adequate and proper treatment. This study aims to investigate further the various types of fungi involved in otomycosis and test their susceptibility against common antifungals. In total, among candidiasis-suspected patients, 60 samples were incorporated into the study. PCR method was used for Candida species detection. Broth microdilution method of Clinical and Laboratory Standards Institute document M60 was applied to assess MIC values of rampant antifungals. We used SPSS software (version 16.0) for statistical analysis. In this survey, 20, 3, and 1 type of Candida albicans, Candida parapsilosis, and Candida glabrata were identified, respectively. All 20 C. albicans isolates were sensitive to amphotericin B (range 0.03-1 μg/ml), voriconazole, (0.03-1 μg/ml), and itraconazole (0.03-0.5 μg/ml.); moreover, one isolate was resistant to fluconazole. Two isolates out of three isolates of C. parapsilosis, were susceptible to all agents while the other one isolate was resistant to fluconazole. C. glabrata isolate was susceptible to all agents. In summary, the results conveyed the importance of clinicians remaining vigilant in diagnosing otomycosis due to its non-specific manifestations. To manage effectively otomycosis and avoid complications or recurrence, it is imperative to diagnose the condition at the earliest time, confirm its virulence through various tests, and identify antifungal susceptibility patterns. Despite this, relapse is often seen and achieving complete remission can prove to be a major hurdle in individuals who have had mastoidectomy and those with weakened immune systems.
In Vitro Antifungal Activity of Luliconazole, Efinaconazole, and Nine Comparators Against Aspergillus and Candida Strains Isolated from Otomycosis
Jundishapur Journal of Microbiology, 2021
Background: Aspergillus and Candida species are the most commonly identified fungal pathogens in otomycosis. However, we usually encounter some difficulties in its treatment because many patients show resistance to antifungal agents and present a high recurrence rate. Objectives: The current research was conducted to compare the in vitro activities of luliconazole (LUL), and efinaconazole (EFN) and the nine comparators on Aspergillus and Candida strains isolated from otomycosis. Methods: The in vitro activities of nine common antifungal drugs (amphotericin B (AMB), voriconazole (VRC), fluconazole (FLU), itraconazole (ITC), ketoconazole (KTO), clotrimazole (CLO), nystatin (NYS), terbinafine (TRB), and caspofungin (CAS)) and two novel new azoles (LUL and EFN) against 108 clinical isolates of Aspergillus and Candida species obtained from otomycosis were assessed according to the CLSI broth microdilution document. Results: The LUL and EFN had the geometric mean minimum inhibitory concen...
Otomycosis in the north of Iran: common pathogens and resistance to antifungal agents
European Archives of Oto-Rhino-Laryngology, 2013
Otomycosis as a kind of external otitis can be caused by various species of fungi. To use the appropriate treatment, it is necessary to identify the causal agent of otomycosis. The aim of this study was to determine the pathogens that caused otomycosis and also the efficacy of different antifungal agents. 100 patients with diagnosis of otomycosis/otitis extern were entered in this study. Bacterial culture was performed by eosin methylene blue agar, blood agar; and Sabouraud dextrose agar was used to culture the fungal agents. Minimum inhibitory concentration test also was performed to determine the efficacy of Clotrimazole, Fluconazole, Ketoconazole and Nystatin on the fungal pathogens. Otomycosis was confirmed in 43 % of patients by positive culture. The most prevalent fungal pathogen was Aspergillus niger which was sensitive to Clotrimazole, Fluconazole, Ketoconazole. Candida albicans was sensitive to all drugs, in which, the most sensitivity was due to fluconazole. The most frequent fungal pathogen in our otomycosis cases is A. niger, and most of fungi that caused otomycosis are sensitive to clotrimazole. Keywords Otomycosis Á Clotrimazole Á External otitis Á Aspergillus niger Á Candida albicans Á Minimum inhibitory concentration (MIC)
In Vitro Antimycotic Activity of Four Medicinal Plants Versus Clotrimazole in the Treatment of Otomycosis: A Preliminary Study
Philippine Journal of Otolaryngology-Head and Neck Surgery, 2008
To determine the antimycotic activity of the four medicinal plant extracts, kalachuchi bark (Plumeria acuminata Ait.), atsuete bark (Bixa orellana Linn.), akapulko leaves (Cassia alata Linn.), and neem leaves (Azadirachta indica Adr. Juss), when compared to the standard clotrimazole in the treatment of otomycosis. Study Design: Experimental Study Methods: Taxonomically identified plants, kalachuchi, atsuete, akapulko, and neem tree were collected and deposited in an herbarium. Extracts of these plants and the standard clotrimazole were tested against isolates of Aspergillus flavus, Aspergillus niger, and Candida albicans taken from patients with otomycosis. Three trials were made for each extract using different solvents and results subjected to statistical analysis. Result: Of the four medicinal plant extracts studied, only kalachuchi bark extract exhibited antifungal activity against Aspergillus flavus and Aspergillus niger using methylethylketone as solvent when compared to the standard clotrimazole. It was equally effective in inhibiting the growth of A. flavus and A. niger. However, all plant extracts using all types of solvents were equally ineffective in inhibiting the growth of Candida albicans. Conclusion: This in vitro study suggested that kalachuchi (Plumeria acuminata Linn.) bark extract inhibits the growth of Aspergillus species and was comparable to the standard clotrimazole. Following appropriate further studies and clinical trials, it may be a potential alternative treatment option for otomycosis caused by Aspergillus species.
Old is Gold . Topical Clotrimazole Remains an Effective Treatment of Otomycosis
2015
Introduction: Otomycosis also known as fungal otitis externa has typically been described as fungal infection of the external auditory canal. The prevalence of otomycosis has been reported to be as low as 9% of cases of otitis externa and as high as 30.4% in patients presenting with symptoms of otitis or inflammatory conditions of the ear. The most common fungal agents causing otomycosis are aspergillus niger (80%), candida albicans (second most common), actinomyces, trichophyton, aspergillus fumigatus and candida tropicalis. Methods: It was descriptive case series of six months duration done at department of ENT, Islamabad Medical and Dental College Islamabad. Sample size was 119, using 50%8 efficacy of topical clotrimazole, 95% confidence level and 9% margin of error under WHO software for sample size determination. Results: A total of 119 patients of otomycosis were included in the study. Male to female ratio was 0.61:1. Average age of the patients was 32.94 years ± 5.24 SD with ...
EVALUATION OF THERAPEUTIC EFFICIENCY OF TOPICAL CLOTRIMAZOLE AND TOPICAL MICONAZOLE IN THE TREATMENT OF OTOMYCOSIS- A PROSPECTIVE STUDY
National Journal of Medical Research, 2015
Background: Otomycosis a Superficial Fungal Infection of the External auditory canal causes lot of misery to the Patient with tendency of recurrence. Many Antifungals are used for treatment with different percentage of success; still a standard regime is not firmly established. So this study is undertaken to evaluate Therapeutic efficiency of Topical Clotrimazole and Miconazole in treating Otomycosis. Materials and Methods: Present study was conducted on 156 clinically diagnosed cases of Otomycosis. Ear discharge was collected. Identification of fungi was done by standard protocol. Out of 156 cases 135 cases produced positive fungal isolates which were taken for further studies. Cases underwent thorough cleaning in Infected Ear. 1% Clotrimazole Ear drop was used in 70 cases and 1% Miconazole in 65 cases for 1 week and followed up for 1 week to 2 months for clearance or recurrence. Results: Clotrimazole showed good response Symptomatically and Mycological clearance within one week in 66 cases. Persistence of disease to 2-4 weeks in 4 cases and no recurrence within 2 months of follow up with minimal side effects, Where as Miconazole showed good response within one week in 54 cases, 9 cases had persistence of disease to 2-4 weeks and 2 cases had recurrence, burning sensation in 9 patients and 1 case developed allergy and discontinued treatment. Conclusion: Topical Clotrimazole is more Effective, Safe and well tolerated with better Symptomatic relief, Mycological clearance and low relapse rate compared to Topical Miconazole.
Role of Clotrimazole in Prevention of Recurrent Otomycosis
BioMed Research International, 2019
Otomycosis is one of the relatively common diseases in the world which is caused by different fungi especially saprophytes. Concerning the relapse of this disease in a number of individuals, the present study was performed to evaluate the inhibitory effect of clotrimazole drop in the relapse of otomycosis. Clinical samples were taken by an ENT specialist from patients suspicious of having otomycosis. A part of these samples were stained, and others were cultured. The diagnosis of otomycosis was made on the basis of the recognizable and characteristic appearance of fungal hyphae or mycelium and fruiting bodies and/or conidiophores under microscopic examination. Patients with suspected otomycosis are not at risk of recurrence after treatment with clotrimazole drops. Out of the 161 individuals in whom definite diagnosis of otomycosis was made, the most affected individuals were, in the age range of 40–49 years, women, urban citizens, and housewives. Pruritus and diminished hearing were...
The high efficacy of luliconazole against environmental and otomycosis Aspergillus flavus strains
Iranian Journal of Microbiology, 2020
Background and Objectives: Luliconazole is currently confirmed for the topical therapy of dermatophytosis. Moreover, it is found that luliconazole has in vitro activity against some molds and yeast species. The aim of the present study was to evaluate the efficacy of luliconazole in comparison to routine used antifungals on clinical and environmental isolates of Aspergillus flavus. Materials and Methods: Thirty eight isolates of A. flavus (18 environmental and 20 clinical isolates) were detected based on morphological and microscopic features and also PCR-sequencing of β-tubulin ribosomal DNA gene. All the isolates were tested against luliconazole, voriconazole, amphotericin B and caspofungin. Minimum inhibitory concentration (MIC), 90 MIC50, MIC isolates. and MIC Geometric (GM) were calculated using CLSI M38-A2 protocol for both environmental and clinical GM Results: Luliconazole with extremely low MIC range, 0.00049-0.00781 μg/mL and MIC 0.00288 μg/mL showed very str...
Loading Preview
Sorry, preview is currently unavailable. You can download the paper by clicking the button above.