Clioquinol for Otomycosis: A Lesser Understood Antimicrobial:
To the Editor: Peled et al. (1) provide a detailed analysis of their experience with otitis externa. Treatment of this disease should be augmented with knowledge of the following antimicrobial which is less well understood in comparison to more traditional topical antibacterial and antimycotic agents. Clioquinol is a halogenated 8-hydroxyquinoline (also known as iodochlorohydroxyquin) and is primarily used for its antimicrobial activity (2). It has been marketed under many different proprietary names worldwide in both otic solutions and skin creams. Since clioquinol is not a member of commonly-used and broadly active antimicrobial families, little specific knowledge of it is had by the vast majority of medical practitioners. Yet, there are many physicians that are more likely to use clioquinol anecdotally than many other antimicrobials that are formally explored in their medical training, even though the drug's indications are very limited.
Introduced in the 1930s as a medicinally useful quinoline derivative for its antiseptic potential, clioquinol was intended to be a topical treatment for skin wounds and superficial infections. Clinical application became common well before rigorous clinical trials were ever completed. It then became a component of various dermatological preparations, often combined with one or more other pharmaceuticals. Clioquinol was formerly administered orally as a prophylactic agent for traveller's diarrhea and as an anti-amoebic agent. Although limited for oral absorption, blood levels have been found, and skin absorption, once thought incapable, is now acknowledged (3,4).
The drug has broad antimicrobial activity including many bacteria, yeast, and molds that would be obtained from most external ear or superficial skin infections (5–7). The antibacterial spectrum is broad and includes common Gram-positive cocci, many Gram-negative bacilli, and mycobacteria. The antifungal effects are also broad spectrum (including both Candida spp. and Aspergillus spp.), although as an individual antimycotic, clioquinol is weaker than both clotrimazole and tolnaftate. The specific mechanisms of antimicrobial activity are not well understood, and the drug provides more of a microbistatic than microbicidal action (8). Nevertheless, the concentration of clioquinol in topical preparations is usually 1% to 3% which should exceed required local concentrations many-fold. As a single agent, therefore, clioquinol can be considered a broad spectrum antimicrobial with both antibacterial and antifungal properties.
Although most physicians have likely never heard of clioquinol by name, it was the subject of considerable controversy by the 1970s. Given its initial promise as a traveller's diarrhea and anti-amoebic agent, prophylactic use in large populations became commonplace in some regions of the world. When used orally, however, studies found a dose- and time-related toxicity of the central nervous system including subacute myelo-optic neuropathy and amnesia (9–11). Cumulative data in regards to neurotoxicity then led to a ban on oral clioquinol use in many countries (12). Elsewhere, oral use continues to attract clinical controversy (13).
Skin toxicity from local exposure, or a worsening of eczema has occurred (14,15). Some 0.7 to 2.2% of patients will develop a primary dermatitis with topical clinical applications (16,17). Fixed drug eruptions after topical or other use were also reported (18,19). Patch test sensitivity varied over 0.73 to 12% (20,21). Cross-sensitization to other halogenated compounds has been reported (22). By 1965, flumethasone became available for clinical use as a topical steroid and was thought to be an improvement over hydrocortisone. Some otic solutions contain 1% clioquinol and 0.02% flumethasone pivalate for clinical use. The latter combination with flumethasone has been successfully exploited for the treatment of otitis externa generally and specifically for mycotic otitis externa (23–26). Simultaneous efficacy against both bacterial and mycotic pathogens has attracted such therapeutic interest.
Several precautions with otic use should be observed. Significant absorption of clioquinol systemically with topical ear use is unlikely, but past concerns of neurotoxicity should lead physicians to refrain use in the context of tympanic perforation. Although clioquinol has quite broad antimicrobial activity, resistance among some Gram-negative bacteria has been found. A microbial culture should be obtained when there is seemingly drug failure after 5 to 7 days of application. Given clioquinol's potential to cause a local hypersensitivity reaction, despite being compounded with flumethasone, contact dermatitis due to clioquinol should also be considered in addition to resistant infection when the outer ear pathology continues during extended application.
Back to Top | Article Outline
REFERENCES
1. Peled C, El-Seid S, Bahat-Dinur A, Tzvi-Ran LR, Kraus M, Kaplan D. Necrotizing otitis externa – analysis of 83 cases: clinical findings and course of disease. Otol Neurotol 2019; 40:56–62.
Cited Here... |
View Full Text | PubMed | CrossRef
2. Neldner KH. The halogenated 8-hydroxyquinolines. Int J Dermatol 1977; 16:267–273.
Cited Here... |
PubMed | CrossRef
3. Degen PH, Moppert J, Schmid K, et al. Percutaneous absorption of clioquinol (Vioform®). Dermatologica 1979; 159:295–301.
Cited Here... |
PubMed
4. EditorialClioquinol and other halogenated hydroxyquinolines. Lancet 1968; 1:679.
Cited Here...
5. Regös J, Zak O, Solf R, et al. Antimicrobial spectrum of triclosan, a broad-spectrum antimicrobial agent for topical application. II. Comparison with some other antimicrobial agents. Dermatologica 1979; 158:72–79.
Cited Here... |
PubMed
6. Maher A, Bassiouny A, Moawad K, et al. Otomycosis: an experimental evaluation of six antimycotic agents. J Laryngol Otol 1982; 96:205–213.
Cited Here... |
PubMed | CrossRef
7. You Z, Ran X, Dai Y, Ran Y. Clioquinol, an alternative antimicrobial agent against common pathogenic microbe. J Mycol Med 2018; 28:492–501.
Cited Here... |
PubMed | CrossRef
8. Pippi B, Lopes W, Reginatto P, et al. New insights into the mechanism of antifungal action of 8-hydroxyquinolines. Saudi Pharm J 2019; 271:41–48.
Cited Here... |
PubMed | CrossRef
9. Mao X, Schimmer AD. The toxicology of clioquinol. Toxicol Lett 2008; 182:1–6.
Cited Here... |
PubMed | CrossRef
10. Tateishi J. Subacute myelo-optico-neuropathy: clioquinol intoxication in humans and animals. Neuropathology 2000; 20:S20–S24.
Cited Here... |
PubMed
11. Konagaya M. SMON: toxicity of clioquinol and the status quo. Brain Nerve 2015; 67:49–62.
Cited Here...
12. Wolfe MS, Mishtowt GL. Entero-Vioform in traveler's diarrhea. JAMA 1972; 220:275–276.
Cited Here... |
PubMed | CrossRef
13. van Hunsel F, van Nieuwkoop C, Stricker BHC. Clioquinol use for Dientamoeba fragilis infections is questionable. Ned Tijdschr Geneeskd 2017; 161:D1477.
Cited Here... |
PubMed
14. Saunders TS. The use of Vioform in local dermatologic therapy. Arch Derm Syphilol 1946; 54:456–460.
Cited Here... |
PubMed
15. Maibach HI. Iodochlorohydroxyquin-hydrocortisone treatment of fungal infections. Arch Dermatol 1978; 114:1773–1775.
Cited Here... |
PubMed | CrossRef
16. Bandmann H-J, Calnan CD, Cronin E, et al. Dermatitis from applied medicaments. Arch Dermatol 1972; 106:335–337.
Cited Here... |
PubMed | CrossRef
17. Kero M, Hannuksela M, Sothman A. Primary irritant dermatitis from topical clioquinol. Contact Dermatitis 1979; 5:115–117.
Cited Here... |
PubMed | CrossRef
18. Mussani F, Poon D, Skotnicki-Grant S. Systemic contact dermatitis to topical clioquinol/hydrocortisone combination cream. Dermatitis 2013; 24:196–197.
Cited Here... |
View Full Text | PubMed | CrossRef
19. Janier M, Vignon MD. Recurrent fixed drug eruption due to clioquinol. Br J Dermatol 1995; 133:1013–1014.
Cited Here... |
PubMed | CrossRef
20. Holmes RC, Johns AN, Wilkinson JD, et al. Medicament contact dermatitis in patients with chronic inflammatory ear disease. J Soc Med 1982; 75:27–30.
Cited Here...
21. Meneghini CL, Rantuccio F, Lomuto M. Additives, vehicles and active drugs of topical medicaments as causes of delayed-type allergic dermatitis. Dermatologica 1971; 143:137–147.
Cited Here... |
PubMed
22. Soesman-van Waadenoijen Kernekamp A, van Ketel WG. Persistence of patch test reactions to clioquinol (Vioform®) and cross-sensitization. Contact Dermatitis 1980; 6:455–460.
Cited Here... |
PubMed | CrossRef
23. Bear VD. Otitis externa: immediate and long-term results with flumethasone pivalate/iodochlorhydroxyquinoline ear drops. Med J Aust 1969; 1:273–276.
Cited Here... |
PubMed | CrossRef
24. Khambata AS. Ear dressings in the treatment of otitis externa. Practitioner 1969; 202:269–272.
Cited Here... |
PubMed
25. Sen Gupta RP, Kacker SK. Otomycosis. Ind J Med Sci 1978; 32:5–7.
Cited Here...
26. Herasym K, Bonaparte JP, Kilty S. A comparison of Locacorten-Vioform and clotrimazole in otomycosis: a systematic review and one-way meta-analysis. Laryngoscope 2016; 126:1411–1419.
Cited Here... |
PubMed | CrossRef
Copyright © 2020 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
Πληροφορίες
Ετικέτες
Τετάρτη 11 Δεκεμβρίου 2019
Clioquinol for Otomycosis: A Lesser Understood Antimicrobial
Αναρτήθηκε από
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
στις
11:38 μ.μ.
Ετικέτες
00302841026182,
00306932607174,
alsfakia@gmail.com,
Anapafseos 5 Agios Nikolaos 72100 Crete Greece,
Medicine by Alexandros G. Sfakianakis,
Telephone consultation 11855 int 1193
Εγγραφή σε:
Σχόλια ανάρτησης (Atom)
Αρχειοθήκη ιστολογίου
-
►
2023
(276)
- ► Φεβρουαρίου (133)
- ► Ιανουαρίου (143)
-
►
2022
(1976)
- ► Δεκεμβρίου (116)
- ► Σεπτεμβρίου (158)
- ► Φεβρουαρίου (165)
- ► Ιανουαρίου (161)
-
►
2021
(3661)
- ► Δεκεμβρίου (161)
- ► Σεπτεμβρίου (274)
- ► Φεβρουαρίου (64)
- ► Ιανουαρίου (368)
-
►
2020
(4554)
- ► Δεκεμβρίου (400)
- ► Σεπτεμβρίου (381)
- ► Φεβρουαρίου (638)
- ► Ιανουαρίου (691)
-
▼
2019
(4999)
-
▼
Δεκεμβρίου
(924)
- Happy New Year ! God is our strength. Let Him be t...
- Inability to close mouth and dysphagia caused by p...
- Piperacillin-tazobactam induced bicytopenia in low...
- Acute cerebellar ataxia due to Epstein-Barr virus ...
- Pericardial knock
- Paternal uniparental disomy for chromosome 14: pre...
- Chronic mesenteric ischaemia masked by candida eso...
- History, treatment and analysis of a rare form of ...
- History, treatment and analysis of a rare form of ...
- Extracellular Vesicles from Mesenchymal Stem Cells...
- Signaling Network of Forkhead Family of Transcript...
- Csf1 Deficiency Dysregulates Glial Responses to De...
- Spontaneous Ultraslow Na+ Fluctuations in the Neon...
- Journal of Voice
- Thorough performance evaluation of 213 nm ultravio...
- The Xylella fastidiosa-Resistant Olive Cultivar “L...
- GEO series published today
- Comparative Pharmacokinetic Study of Taxifolin aft...
- Investigating Prime-Pull Vaccination through a Com...
- New GEO Series
- Transcription profiling of dendritic cells differe...
- Chemotherapeutic remodeling of the gut microbiome ...
- DNA methylation and hydroxymethylation mediated ge...
- The histone methyltransferase SETDB1 contributes t...
- HIF1α/HIF2α-miR210-3p network promotes glioblastom...
- H3K27Ac ChIP-seq on Patient Dirived Xenograft (PDX...
- CRISPR/Cas9-mediated gene correction in newborn ra...
- Genome-wide localisation of histone H3S57ph in pro...
- Pathway level gating of auxin signalling provides ...
- Single cell transcriptome sequencing of gastric ca...
- Whole kidneys at embryonic day 16.5: wildtype (WT)...
- Antifungal Activity of Beauveria bassiana Endophyt...
- Immune Responses after Vascular Photodynamic Thera...
- One Anastomosis Gastric Bypass Reconstitutes the A...
- Immune Checkpoint Inhibitor Rechallenge in Patient...
- Ontogenetic Pattern Changes of Nucleobindin-2/Nesf...
- Latent Tuberculosis Infection Treatment Completion...
- The Chromatin Remodelling Contributions of Snf2l i...
- CD271/p75NTR is a novel diagnostic marker, prognos...
- Chemogenomic profiling of breast cancer patient-de...
- Sequencing of canine and genetically-engineered mo...
- Telomeres suppress the activity of retrotransposon...
- Bu Shen Zhu Yun Decoction Improves Endometrial Rec...
- Multicentre, non-interventional study of the effic...
- Finding/identifying primaries with neck disease (F...
- Intermittent theta burst stimulation applied durin...
- Multidimensional impact of severe mental illness o...
- Clinical evaluation of percutaneous transforaminal...
- Digital phenotyping for assessment and prediction ...
- Research priorities in children requiring elective...
- Complications after surgery for benign prostatic e...
- Identifying patient concerns during consultations ...
- Better before-better after: efficacy of prehabilit...
- Elderly migrants : Effect of social integration on...
- Pattern and probability of dispensing of prescript...
- Improving mental health and physiological stress r...
- B!RTH: a mixed-methods survey of audience members ...
- Vitamin D in the prevention of exacerbations of as...
- Advanced practice nurses, registered nurses and me...
- Complement activation in individuals with previous...
- Thyroid Hormone Receptor β Inhibits Self-Renewal C...
- Macrofollicular Variant of Follicular Thyroid Carc...
- Trained immunity confers broad-spectrum protection...
- IGFBP7 acts as a negative regulator of RANKL‐induc...
- Subgingival Instrumentation for Treatment of Perio...
- The Spine Functional Index
- Sarcomatoid Dedifferentiation in Renal Cell Carcin...
- Negative Impact of Wound Complications on Oncologi...
- Nanoformulated Zoledronic Acid Boosts the Vδ2 T Ce...
- Autophagy in the Immunosuppressive Perivascular Mi...
- Molecular Profiling of Atypical Tenosynovial Giant...
- Biomarkers of meat and seafood intake: an extensiv...
- Non ‐alcoholic steatohepatitis mimicking solitary ...
- Diffusion-Weighted MR Imaging of Primary and Secon...
- Clear cell carcinoma of the anterior abdominal wal...
- Sister Mary Joseph nodule: an often overlooked or ...
- Superb microvascular imaging technique in depictin...
- Protean Manifestations and Diagnostic Challenges I...
- Thyroid Dose Estimates for a Cohort of Belarusian ...
- Dose to Medical Personnel
- Factors Determining Work Arduousness Levels among ...
- Treatment of Miller Class I Gingival Recession wit...
- Vitamin K and Bone Health: A Review on the Effects...
- Laparoscopic Partial Nephrectomy for cT1 Tumors
- A Non-Interventional Pilot Study to Explore the Ro...
- Anlotinib Combined With TACE in Hepatocellular Car...
- Testing the Addition of the Immunotherapy Drug, Pe...
- Management of Cognitive Difficulties After Cancer ...
- Nab-paclitaxel Versus Topotecan As Second-Line Tre...
- Sintilimab Combined With Bevacizumab for Brain Met...
- SHR-1210 Combined With Albumin-bound Paclitaxel an...
- Heated Intra-peritoneal Chemotherapy With Doxorubi...
- Ribociclib and Spartalizumab in R/M HNSCC
- Biomolecules, Vol. 10, Pages 66: The Emerging Role...
- Evaluating the effectiveness of adjuvant radiother...
- Examining seasonal variation in epistaxis in a mar...
- Is the survival rate for acral melanoma actually w...
- The Improved Effects of a Multidisciplinary Team o...
- Treatment of an Adult Skeletal Class III Patient w...
- Significant influencing factors and practical solu...
- ► Σεπτεμβρίου (845)
-
▼
Δεκεμβρίου
(924)
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου