From the Research
Oral management of uncomplicated otomycosis is not typically recommended as the first line of treatment, and instead, topical antifungal medications such as clotrimazole or miconazole are preferred. According to the most recent and highest quality study available, 1, topical azole treatments are effective for otomycosis, and there is no significant difference between different types of azoles in terms of clinical resolution. However, if oral treatment is necessary, fluconazole or itraconazole may be prescribed, but only for cases that don't respond to topical treatments, extensive infections, or when patients have compromised immune systems. For adults, fluconazole can be prescribed at 150-200 mg once daily for 7-14 days, while itraconazole may be given at 100 mg twice daily for a similar duration. Children's dosing should be adjusted based on weight, typically 3-6 mg/kg/day for fluconazole. Before starting oral therapy, the ear canal should be thoroughly cleaned of debris by a healthcare provider.
- Oral antifungals work by disrupting the fungal cell membrane, preventing growth and reproduction of the fungal organisms.
- Patients should complete the full course of medication even if symptoms improve earlier.
- Common side effects include gastrointestinal upset, headache, and potential liver enzyme elevations, so monitoring may be necessary for longer treatment courses.
- Concurrent use of topical antifungal preparations can enhance treatment efficacy.
- Patients should keep their ears dry during treatment and avoid inserting objects into the ear canal to prevent reinfection. It's worth noting that the evidence from 2, 3, 4, and 5 also supports the use of topical antifungal medications as the primary treatment for uncomplicated otomycosis, and oral antifungals should be reserved for more severe or complicated cases.