(0963) Terbinafine Versus Clotrimazole as Topical Treatment for Otomycosis: A Randomized Controlled Trial

Introduction: Otomycosis is an inflammatory and infectious process of the external ear due to fungal infection. Aspergillus and Candida are the most frequently reported fungi. There are few studies that compare the efficacy of terbinafine vs clotrimazole in the treatment of otomycosis.

Methods: Randomized controlled trial in a secondary care center from July 2022 to October 2023. Thirty-two patients with otomycosis were randomly assigned, sixteen patients received weekly topical clotrimazole and 16 patients weekly topical terbinafine. Patients were followed up every week for 1 month. The outcome variables were cure rate and recurrence. Patients who did not respond to one therapy were assigned to the other topical treatment. Recurrence or additional response failure were treated with systemic antifungal therapy (itraconazole).

Results: At two weeks, ten patients (62.5%) improved with topical clotrimazole and 8 (50%) with topical terbinafine. Five patients initially assigned to clotrimazole did not experience improvement and were subsequently switched to terbinafine, resulting in a cure rate of 80% (n=4). Additionally, six patients originally treated with terbinafine were switched to clotrimazole, achieving a cure rate of 33% (n=2).
One patient in the clotrimazole group received itraconazole, versus n=4 of terbinafine patients. Aspergillus was detected in 62.5% (n=20) of patients and Aspergillus flavus was the most common species in 50% (n=10). At one month, recurrence was n=2 in the clotrimazole group and n=2 in the terbinafine group. Three patients were excluded due to bacterial infection.

Conclusions: Topical clotrimazole remains the treatment of choice for otomycosis, terbinafine is a good alternative treatment.