Clotrimazole cream more effective than Tolnaftate for uncomplicated otomycosis: Study

A recent study conducted in Mexico found that topical Clotrimazole cream is more effective than Tolnaftate for uncomplicated otomycosis. The study was published in the journal 'Brazilian Journal of Otorhinolaryngology' 2020.

Otomycosis is a common condition encountered in the general Otolaryngology clinic setting. Otomycosis is an infection of the ear canal which is caused by fungi and is prevalent in hot and humid weather. Local debridement, local and systemic antifungal agents and discontinuation of topical antibiotics are the general treatment recommendations.

Still, there is not sufficient evidence on the effectiveness of various available topical antifungal agents. Tolnaftate, is a topical antifungal agent described to be effective in the treatment of otomycosis. Researchers from Mexico conducted an open randomized control trial on 48 to study the efficacy of Tolnaftate and compare it with clotrimazole.

Patients who were diagnosed with fungal external otitis and who were treated with topical antifungals, were randomly divided into two treatment groups called the Clotrimazole cream which had 28 patients and Tolnaftate solution which had 20 patients. They were microscopically evaluated at one and two weeks of treatment to determine the resolution of disease. Collection and analysis of demographic and clinical variables was done.

On comparing the final outcome the following was found:

• Spring season was most associated with otomycosis.
• Otic manipulation was the risk factor more common in both groups.
• Predominant symptoms were itching and otic fullness.
• Aspergillus niger organism was most frequently isolated.
• Treatment resolution with clotrimazole was 75%, while with tolnaftate it was 45% treatment at one week (p = 0.007).
• The Tolnaftate treatment group demonstrated higher recurrence rates and treatment failures of 20% and 15% respectively.

Thus, the authors concluded that Clotrimazole cream treatment is more effective than Tolnaftate for uncomplicated otomycosis. They also added that further studies are needed to corroborate the results.  

For further reading, click the following link: https://doi.org/10.1016/j.bjorl.2018.12.007