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Treatment of refractory Aspergillus otomycosis with voriconazole: case series and review

Published online by Cambridge University Press:  09 June 2014

Hsu-Chueh Ho ,
Shih-Hsuan Hsiao ,
Cheng-Yung Lee  and
Chen-Chi Tsai
Hsu-Chueh Ho
Affiliation:
Division of Otorhinolaryngology, Department of Surgery, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan
Shih-Hsuan Hsiao
Affiliation:
Division of Otorhinolaryngology, Department of Surgery, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan
Cheng-Yung Lee
Affiliation:
Division of Otorhinolaryngology, Department of Surgery, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan
Chen-Chi Tsai*
Affiliation:
School of Medicine, Tzu Chi University, Hualien, Taiwan Division of Infectious Diseases, Department of Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan
*
Address for correspondence: Dr Chen-Chi Tsai Division of Infectious Disease, Department of Medicine, Buddhist Dalin Tzu Chi Hospital, No. 2, Minsheng Road, Dalin Township, Chiayi County 62247, Taiwan Fax: +886 5 2648999 E-mail: antibody_1@msn.com
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Abstract

Background:

Voriconazole is a broad-spectrum azole exhibiting strong anti-Aspergillus activity and good long-term tolerance. However, the evidence for voriconazole efficacy against refractory Aspergillus otomycosis is weak.

Method:

We reviewed the medical records of patients with Aspergillus otomycosis treated with voriconazole from January 2008 to June 2012 in a Taiwanese regional hospital. Demographic data and information regarding underlying diseases, clinical features, treatment and outcome were assessed.

Results:

In total, 14 cases of Aspergillus otomycosis were treated with voriconazole, including 5 patients with Aspergillus invasive otitis externa. All patients had failed to respond to local treatment, antibiotics or topical agents. One case was lost to follow up. The symptoms of two patients recurred after voriconazole treatment: one patient received a second 12-week course of voriconazole and was cured; and symptoms of the other patient recurred after a second 12-week course of voriconazole, leading to surgical debridement. The remaining 11 patients were cured by voriconazole treatment without extensive surgical debridement.

Conclusion:

This study demonstrates that voriconazole can be a very effective and convenient therapeutic option for the management of refractory Aspergillus otomycosis.

Keywords

VoriconazoleAspergillusOtitis ExternaOtomycosis
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 6 , June 2014 , pp. 547 - 551
Copyright
Copyright © JLO (1984) Limited 2014 

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