Efficacy of clotrimazole for the management of oral candidiasis: A meta-analysis of randomized clinical trials.

PURPOSE: To assess the efficacy and safety of topical application of clotrimazole versus others in the treatment of oropharyngeal candidiasis (OPC). METHOD: Four electronic databases, registries of ongoing trials, and manual search were used to identify randomized controlled trials (RCTs) that compared the efficacy of clotrimazole to other antifungal agents in patients who were clinically diagnosed with oral candidiasis up to November 1st, 2019. Primary outcomes were clinical response and mycological cure rates. Secondary outcomes include relapse rate, incidence of systemic infections, and compliance. Adverse effects were also evaluated. RESULTS: Sixteen RCTs with a total of 1685 patients were included. Half of the eligible studies were considered at high risk of performance bias and more than a third, at high risk of reporting bias. Our analysis showed no significant difference in clinical response between clotrimazole and all other antifungal agents. However, clotrimazole was less effective in terms of mycologic cure and relapse rate. Sensitivity analysis comparing clotrimazole to other topical antifungal agents only showed no differences in clinical response, microbiologic cure or relapse. Further sensitivity analysis showed significant efficacy of fluconazole over clotrimazole. CONCLUSION: This meta-analysis indicated that clotrimazole is less effective than fluconazole but as effective as other topical therapies in treating OPC. Well-designed high-quality RCT is needed to validate these findings.

Staphylococcus lugdunensis from gluteal abscess to destructive native triple valve endocarditis.

We herein present the case of a 43-year-old male diabetic patient who presented with an aggressive form of infective endocarditis involving the tricuspid, mitral and aortic valves following a gluteal abscess due to infection with Staphylococcus lugdunensis. This coagulase-negative organism which is generally considered a component of the normal flora of the skin has however recently emerged as an unusually virulent pathogen responsible for both nosocomial and community-acquired infections. The case demonstrates the importance of paying utmost attention and ensuring a logical conclusion to the identification of persistent coagulase-negative blood cultures. In addition, it also shows the importance of early identification of this organism and aggressive antibiotic administration to avert endocarditis because of the unusual virulence of the organism. Staphylococcus lugdunensis is rarely a clinical specimen contaminant, and its isolation warrants further investigation and concerted treatment.

Pacemaker lead endocarditis due to Brucellosis.

Infection of prosthetic devices or implants is a rare complication of Brucellosis. Pacemakers and implantable cardioverter-defibrillator infections were previously reported in 6 patients. We report the first case of relapsing Brucellosis due to intracardiac lead endocarditis, which resolved only after removing the intracardiac leads and institution of appropriate antimicrobial therapy.

Peritonitis due to Mycobacterium fortuitum following gastric banding.

Mycobacterium fortuitum is a rapid growing nontuberculous organism that has rarely been associated with peritonitis in an otherwise healthy host. We describe a patient who developed peritonitis due to the organism after gastric banding operation, which resolved after removal of the gastric band and institution of appropriate antibiotic therapy.