In a randomised, controlled trial in Thailand, 1% clotrimazole solution has been found to be more effective at treating otomycosis than its cheaper alternative, 3% boric acid in 70% isoproypyl alcohol.
Otomycosis is a worldwide superficial fungal infection of the external auditory canal and auricle which is more prevalent in tropical zones.
Dr S Romsaithong and colleagues compared 1% clotrimazole solution with 3% boric acid in 70% alcohol at Khon Kaen Hospital in Thailand, where otomycosis has been reported in 11% of patients presenting with inflammatory conditions of the ear canal.
The trial was double-blind, controlled and randomised. Trial and patients’ ear canals were examined under the operating microscope one week after a single application of the treatment.
Their condition was either classified as cured or not cured, based on the presence or absence of fungus.
The cure rate for the clotrimazole group was significantly higher with 85.2%, compared to 67.3% for the boric acid group, giving an absolute difference of 17.9% (p = 0.028).
The results of this study concurred with similar previous controlled trials.
The secondary outcome of the study revealed that patients treated with clotrimazole also reported fewer adverse events. While this study lacked long-term follow up of treatments, it was evident that a single application of 1 % clotrimazole solution is both more effective at treating otomycosis and less irritating than 3% boric acid in 70% alcohol.
Abstract
To compare the clinical effectiveness and adverse events for 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in the treatment of otomycosis.
A total of 120 otomycosis patients were randomly assigned to receive either 1 per cent clotrimazole solution (intervention group) or 3 per cent boric acid in 70 per cent alcohol (control group) at the Khon Kaen Hospital ENT out-patient department. Treatment effectiveness was determined based on the otomicroscopic absence of fungus one week after therapy, following a single application of treatment.
After 1 week of treatment, there were data for 109 participants, 54 in the clotrimazole group and 55 in the boric acid group. The absolute difference in cure rates between 1 per cent clotrimazole solution and 3 per cent boric acid in 70 per cent alcohol was 17.9 per cent (95 per cent confidence interval, 2.3 to 33.5; p = 0.028) and the number needed to treat was 6 (95 per cent confidence interval, 3.0 to 43.4). Adverse events for the two agents were comparable.
One per cent clotrimazole solution is more effective than 3 per cent boric acid in 70 per cent alcohol for otomycosis treatment.
Authors
S Romsaithong, K Tomanakan, W Tangsawad, S Thanaviratananich
[link url="http://www.life-worldwide.org/media-centre/article/1-clotrimazole-more-effective-than-3-boric-acid-in-alcohol-for-otomycosis-r"]Life-Worldwide material[/link]
[link url="https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/div-classtitleeffectiveness-of-3-per-cent-boric-acid-in-70-per-cent-alcohol-versus-1-per-cent-clotrimazole-solution-in-otomycosis-patients-a-randomised-controlled-trialdiv/E1BA7146E351475F4E868DBFF587B071"]The Journal of Laryngology and Otology abstract[/link]