Herasym Khrystyna, Bonaparte James P, Kilty Shaun
Department of Medicine, University of Ottawa, Ottawa, Canada.
Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Canada.
Laryngoscope. 2016 Jun;126(6):1411-9. doi: 10.1002/lary.25761. Epub 2015 Nov 24.
OBJECTIVES/HYPOTHESIS: The goal of this systematic review was to compare the efficacy and ototoxicity of Locacorten-Vioform (Paladin Labs Inc., Montreal, Quebec, Canada) and clotrimazole in the treatment of patients with otomycosis.
Embase, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, World Health Organization International Clinical Trials Registry Platform, European Union Clinical Trials Register, Cochrane Library databases of clinical trials, and ClinicalTrials.gov.
We included any randomized controlled trials or nonrandomized studies (case-control, cohort, and case series) assessing the topical use of Locacorten-Vioform (Paladin Labs Inc.) and/or clotrimazole in adult and/or pediatric immunocompetent patient population with otomycosis. DerSimonian and Laird's random effects approach was used for meta-analysis, followed by an assessment of heterogeneity and subgroup analysis.
Of 226 reviewed articles, 14 were retained. Clotrimazole efficacy rate was 85% (95% confidence interval [CI]: 79.7-89.0%), whereas Locacorten-Vioform (Paladin Labs Inc.) was 73% (95% CI: 56.0-84.5%). Overall, study quality was low. There was high heterogeneity in both groups (I(2) of 47 and 49). There were only three studies assessing Locacorten-Vioform (Paladin Labs Inc.); therefore, comparative assessment was not possible. A one-way meta-analysis involving 13 clotrimazole studies was performed. Heterogeneity across studies was high; however, studies using objective analysis assessing treatment efficacy, randomized controlled trials, studies using drops, studies performed in Asia, and studies where Candida was the major fungus at diagnosis demonstrated low heterogeneity.
Although both are safe and effective, there is insufficient evidence supporting increased efficacy of either clotrimazole or Locacorten-Vioform (Paladin Labs Inc.) for the treatment of otomycosis. High-quality comparative studies are required.
N/A. Laryngoscope, 126:1411-1419, 2016.
目的/假设：本系统评价的目的是比较洛卡考特 - 维奥仿（加拿大魁北克省蒙特利尔市圣骑士实验室公司）和克霉唑治疗耳霉菌病患者的疗效和耳毒性。
Embase、护理及相关健康文献累积索引、MEDLINE、世界卫生组织国际临床试验注册平台、欧盟临床试验注册库、Cochrane图书馆临床试验数据库以及ClinicalTrials.gov。
我们纳入了任何评估洛卡考特 - 维奥仿（圣骑士实验室公司）和/或克霉唑在患有耳霉菌病的成人和/或儿童免疫功能正常患者群体中局部使用情况的随机对照试验或非随机研究（病例对照、队列和病例系列）。采用DerSimonian和Laird随机效应方法进行荟萃分析，随后评估异质性并进行亚组分析。
在226篇综述文章中，保留了14篇。克霉唑的有效率为85%（95%置信区间[CI]：79.7 - 89.0%），而洛卡考特 - 维奥仿（圣骑士实验室公司）为73%（95% CI：56.0 - 84.5%）。总体而言，研究质量较低。两组均存在高度异质性（I²分别为47和49）。仅有三项研究评估了洛卡考特 - 维奥仿（圣骑士实验室公司）；因此，无法进行比较评估。对涉及13项克霉唑研究进行了单向荟萃分析。各研究间异质性较高；然而，使用客观分析评估治疗效果的研究、随机对照试验、使用滴剂的研究、在亚洲进行的研究以及诊断时念珠菌为主要真菌的研究显示异质性较低。
虽然两者均安全有效，但没有足够证据支持克霉唑或洛卡考特 - 维奥仿（圣骑士实验室公司）在治疗耳霉菌病方面疗效更高。需要高质量的比较研究。
无。《喉镜》，2016年，第126卷，第1411 - 1419页。
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