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. 2021 Apr;29(4):315-323.
doi: 10.1016/j.jsps.2021.03.003. Epub 2021 Mar 24.

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

Thamer A Almangour  1 , Keith S Kaye  2 , Mohammed Alessa  1 , Khalid Eljaaly  3   4 , Fadilah Sfouq Aleanizy  5 , Aynaa Alsharidi  6 , Fahad M Al Majid  6 , Naif H Alotaibi  6 , Abdullah A Alzeer  1 , Faris S Alnezary  7   8 , Abdullah A Alhifany  9
Affiliations

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

Thamer A Almangour et al. Saudi Pharm J. 2021 Apr.

Abstract

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.

Keywords: CI, confidence interval; Clotrimazole; HIV, human immunodeficiency virus; Meta-analysis; OPC, oropharyngeal candidiasis; OR, odds ratio; Oral candidiasis; Systematic review.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Search strategy: Study selection process using preferred reporting items for systematic reviews and meta-analysis (PRISMA).
Fig. 2
Fig. 2
Risk of bias graph: review authors’ judgement about each risk of bias item presented as percentages across all included studies.
Fig. 3
Fig. 3
Risk of bias summary: review authors’ judgement about each risk of bias item for each included study.
Fig. 4
Fig. 4
Forest plots for the evaluation of clotrimazole versus fluconazole in the treatment of oropharyngeal candidiasis. (A) Clinical response, (B) Mycological Cure, (C) Relapse rate (Fixed-effect analysis), and (D) Relapse rate (Random-effect analysis).
Fig. 5
Fig. 5
Forest plots for the evaluation of clotrimazole versus other topical antifungal agents in the treatment of oropharyngeal candidiasis. (A) Clinical response, (B) Mycological Cure, (C) Relapse rate.
See this image and copyright information in PMC

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