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The combination of topical fungicide and glucocorticoids has been proven as a successful therapy of cutaneous mycoses with accompanying inflammatory reactions, particularly when used at an early stage. Various national and international therapeutic guidelines recommend this practice. In this context, two individually manufactured formulations have been developed and tested for stability: the combination of methylprednisolone aceponate-a topical glucocorticoid with the therapeutic index of 2.0-with clotrimazole and with ciclopirox olamine, respectively. This has been conducted in compliance with the requirements for quality controlled extemporaneous formulations and the legal framework of the German Pharmacy Working Regulations (Apothekenbetriebsordnung). There are now two formulations for clinical use that are microbiologically, physically, and chemically stable, which combine methylprednisolone aceponate-a glucocorticoid with a good risk-benefit ratio-with the broad-spectrum fungicides clotrimazole and, for the first time, ciclopirox olamine.

The important aspect of a successful therapy for otitis externa is cleaning of the external canal. Several cleaners are available for this purpose. In the light of increasing bacterial resistance against antibiotics a combined therapy with antiseptics is desirable. The aim of this study was to evaluate the efficacy of a cleaner containing chlorhexidine (1500µg/ml) and Tris-EDTA (48µg/ml) clinically, cytologically and microbiologically in a placebo-controlled double-blinded trial.In 64 dogs ear cleaner (group A) or placebo (group B) was used twice daily followed by an ear medication containing marbofloxacin/dexamethasone/clotrimazole once daily. After 2 weeks patients were re-evaluated clinically and cytologically. In addition at the beginning and after 14 days an ear swab of each ear underwent a microbiological examination and sensitivity testing.On cytology, there was a significant reduction in the count of cocci (p0.0001), rods (p=0.007) and neutrophils (p=0.0001) in the treatment compared to the placebo group. Yeasts were significantly reduced in both groups (group A p0.0001, group B p0.001). Clinical examination did not reveal a significant difference between the two groups (p=0.59). The number of marbofloxacin-resistant bacteria increased in group A from 0 to 44% (p=0.0025) and in group B from 8 to 31% (p0.05).Chlorhexidine and Tris-EDTA in combination with marbofloxacin/dexamethasone/clotrimazole were effective in cytological reduction of bacteria in canine infectious otitis externa. The number of marbofloxacin-resistant bacteria increased significantly.Based on this study, chlorhexidine and Tris-EDTA in combination with antimicrobial ear medication can be assumed to be recommended for the treatment of otitis externa complicated by bacterial infection to reduce bacteria, however the high risk of resistance development exists. Side effects are to be expected.

Malassezia folliculitis (synonym: Pityrosporum folliculitis) is a polymorphic dermatomycosis characterized by the development of small papules and pustules. In severe cases, molluscoid comedonal papules are typical. The disease occurs mainly in sebum-rich areas of the face, back and chest, frequently affecting patients under immunosuppressive therapy. We report a case of Malassezia folliculitis observed in a heart transplant recipient who was successfully treated with itraconazole. Moreover, we summarize the taxonomy of the genus Malassezia as well as diagnostic and therapeutic measures of the related folliculitis.

The biography of Dr. Manfred Plempel (1930-1994), Chief Mycologist of the Bayer AG, who developed the first antifungal azole, clotrimazole, for clinical applicability is presented.

Subclinical intrauterine infection is one of the causes of preterm birth. Adjuvant antibiotic treatment can improve the prolongative effects of tocolysis in patients with preterm labour. This study was conducted to evaluate the effectiveness of screening for infection and of antibiotic treatment in reducing postpartal infectious complications in patients with so called idiopathic preterm labour being treated with tocolysis intravenously. At the time of admission, we obtained cervical swabs of 138 patients for bacteriological investigation. 23 of the 37 patients with pathologic cervical colonisation were treated with antibiotics in addition to tocolysis. In women in preterm labour with pathologic cervical microbial colonisation, the frequencies of infectious complications in the puerperium were markedly increased compared to women without cervical colonisation. Adjuvant antibiotic therapy during pregnancy significantly reduced such complications. Additional antibiotic treatment of patients in idiopathic preterm labour with indicators of silent intrauterine infection seems beneficial not only for prolongation of gestation, but also for the reduction of postpartal infectious morbidity.

Using the multilayer membrane system (MMS) the drug availability of four drugs from commercial topical formulations are determined. It was found that the availability differs when commercial formulations of beta-methasone-17-valerate, hydrocortisone, diclofenac-Na and clotrimazole were studied. It is shown that the drug availability for characterizing topical formulations has to be taken into account. The MMS applied in this study can be used for the determination of this parameter.

21 of 41 patients developed clinically manifest or systemic Candida albicans infection 1-36 months after renal transplantation. Asymptomatic candiduria was diagnosed in all patients even before the onset of clinical symptoms. Fungal stomatitis was the most frequent clinical sign, followed by mycotic changes in the respiratory, genito-urinary (vaginitis) and gastro-intestinal tract. In five cases intrahepatic biliary stasis was diagnosed in the course of a Candida albicans septicaemia. In 12 patients with renal transplants it was possible, by treatment with nystatin, clotrimazole, flucytosine, miconazole and amphotericine B to control a generalized or clinically manifest Candida albicans infection. Three died of the septicaemia or meningoencephalitis, six as the result of bacterial superinfections. Inspection of the mouth is an important means of early diagnosing fungal infections. Antimycotic treatment should be started if fungal cultures from urine are repeatedly positive even if the clinical findings are still negative.

A case of infection with Microsporum canis in a German couple which came into contact with cats during holidays in Tunisia is recorded. Atypical clinical features rare localization and the importance of tourism concerning the spread of infections due to Microsporum canis are discussed.

A 19 year old man developed an acute contact dermatitis of the anogenital region after the application of an antimycotic cream containing clotrimazole and azida col. Patch testing revealed sensitization to both active ingredients.

The microscopic, cultural and serological techniques for the diagnosis of European and non-European systemic mycoses involving the respiratory tract are reviewed. The antimicrobial, therapeutic and toxic properties of those antimycotic drugs are discussed, which can be used in the treatment of pulmonary mycoses. Data on biotransformation, kinetics and dosage are reported.

It is reported about the treatment of 39 cases of otomycosis with the local specificum Clotrimazol (chemical term: Bis-phemil-(2 chlorphenyl-)1 imidazol-methan), on the market as "Canestan". In 35 cases complete and permanent healing was observed within a period of 8-12 days. In 2 cases the treatment took 3 weeks. Since irritations of the concha or the cheek below the concha respectively happened only in 2 cases, the compatibility can be regarded as good.

The number of opportunistic yeast infections has increased during the last years. Therefore, testing of antimycotica has become important in terms of reliability and speed. Todays testing is essentially based on the disc diffusion susceptibility test and to a minor extent on the evaluation of the minimal inhibitory concentration. Two disc diffusion tests were compared. Both tests were shown to be practicable as a screening test. However, false positive results were obtained at a rather high percentage. Therefore, a new antimycotica test based on the disc elution test was developed and compared to a disc diffusion test. The resistance patterns for 5-fluorocytosine assayed by the disc elution test were in good agreement to the minimal inhibitory concentration. The test was shown to be adaptable for the imidazole-antimycoticas as well.

According to the examinations of the authors the administration of Canesten vaginal tablets for treatment of vulvovaginitis caused by blastospores resulted in 81% of the cases in a lasting healing, in cases with an affected anamnesis in 75%. With additional treatments of Canesten solution and cream administration the efficiency was further increased and thus results of 90% or 76%, respectively could be achieved. With sanitation of auto- and heteroinfectious foci the recurrences of fungal infections could be avoided. There had been no teratogeneous effects in the newborns following Canesten treatment in pregnants. In course of Clotrimazol administration general characteristic side effects were not observed, a slight and quickly passing inflammation occured in few cases.

The in vitro antimicrobial activity of the antieczematic Bay f 4797 was studied. This combination drug contains the three active components acidamfenicol, clotrimazole and dexamethasone (prospective trade name: Baycuten). Various bacterial and fungal species of importance in dermatology served as test organisms. All the bacterial strains examined were found to be moderately susceptible to acidamfenicol; clotrimazole showed good inhibitory values agaisnt all the fungal species and the gram-positive bacterial strains. Additionally it was checked whether a synergistic or antagonistic interaction occurs with respect to the antimicrobial activity. An interference which could lead to impairment of the therapeutic activity was not observed.

Imidazole derivatives with antifungal activity were investigated in their effects on concentrated and diluted suspensions of Saccharomyces cerevisiae, Candida albicans, and Staphylococcus aureus haemolyticus. Against Candida albicans, activity of the imidazol derivatives was higher in diluted suspensions than in concentrated suspensions: this fact proves the presence of a microbe-count sensitivity. Against Saccharomyces cerevisiae and Staphylococcus aureus haemolyticus, no microbe-count sensitivity of clotrimazole, econazole nitrate, ketoconazole, or N-148/76 could be detected by Warburg assay on resting microbes.

Report on mycological, clinical and therapeutic aspects of candida-albicans conjunctivitis from dermatological, ophthalmological and microbiological viewpoints.

An unselected, mycologically-controlled trial was conducted at the University Children's Hospital of Graz on the treatment of nappy rash by the topical application of Canesten (clotrimazole), a broad-spectrum mycotic in the form of a 1% cream. 56 children, ranging in age from 3 weeks to 41/2 years, were treated for thrush, principally located in the genital area. Only some of the children were admitted primarily on account of the oral and/or perianal moniliasis. The majority of the children were hospitalized for some other reason and thrush was diagnosed as an accompanying condition. Candida albicans proved to be the most frequent pathogenic organism. The results of therapy were judged according to mycological and clinical criteria. The mycological findings became negative in 54 out of the 56 children. Clinical improvement was apparent in all cases between the 5th and 10th day of therapy; complete recovery occurred between the 5th and 25th day, depending on the extent and localization of the moniliasis. One child showed improvement in, but not recovery from the disease, because therapy was interrupted on premature discharge from hospital. Therapy was unsuccessful in the remaining child, although slight improvement occurred. Tolerance was good in all patients on application of Canesten cream thrice daily.

After a brief account of the laboratory and animal studies of 6-cyclohexyl-1-hydroxy-4-methyl-2(1H)-pyridone, 2-aminoethanol salt (ciclopiroxolamine, Cic, Hoe 296, Batrafen) and an outline of previous clinical trials, the results of a double-blind trial with Cic cream and clotrimazole cream are reported, together with those of a large-scale trial of Cic cream in consulting practice. Used for the treatment of skin disorders diagnosed as mycoses, the effectiveness rate of Cic cream ranged from 79 to 98%, depending on the criterion used for assessment. The double-blind trial did not reveal any significant differences between its effect and that of clotrimazole cream. The incidence of side-effects can be regarded as minimal.

Efficacy and tolerability of ointment/water emulsion, containing the combination of clotrimazole and hydrocortisone (Canesten HC) were compared with the two components. 4 groups of indications were chosen and 192 (16 X 3 X 4) patients treated. In all groups and symptoms of this comparison the best efficacy was with the combination product. Side effects which have to be attributed to this topical treatment could not be detected.

The sensitivity against 5 antimycotics was examined with 353 yeast strains of 13 species from clinical material. The tests were carried out by means of the disc diffusion test on Bacto yeast morphology agar under standardized conditions. 33 (6.3%) of the isolates were resistant against 5-fluorocytosine, 11 (2.1%) strains showed no sensitivity against the imidazolyl antimycotics clotrimazole or miconazole. The resistant strains belonged to the species Candida albicans and Candida tropicalis. All of the isolates were sensitive to the polyene antimycotics nystatin and pimaricin (natamycin).

The efficacy of Clotrimazol cream paste containing a penetration enhancer in the treatment of acne vulgaris was objectified by investigating the sebum composition. Following treatment over three and six weeks, the ratio of triglyceride to free fatty acid significantly increased, which indicated an effective reduction of the lipase activity of Propionibacterium acnes within the sebaceous follicle.

In a placebo-controlled double-blind comparative study conducted in 19 healthy volunteers, naftifin hydrochlorid cream was tested against clotrimazole 1%, clotrimazole 1%+hydrocortisone 1%, and various hydrocortisone preparations (0.5%; 1%; 2.5%) for erythema-suppressive effects. The anti-inflammatory effect of naftifine hydrochloride demonstrated earlier was confirmed in this study. The results prove a potency comparable to that of weak topical glucocorticosteroids.

Clotrimazole (Bisphenyl-(2-chlorphenyl)-1-imidazolyl-methan) is a recently developed antimycotic with low human toxicity and a broad antifungal spectrum and is well tolerated by the skin and mucosal surfaces. 1% clotrimazole eye ointment was used by the author in the treatment of five corneal ulcers from which fungi could be isolated. Prompt improvement and complete resolution of the ulcer within 3-8 weeks, depending on the severity of the condition at the beginning of the treatment, were achieved in all cases under clotrimazole therapy. The drug in the preparation used was well tolerated and can be recommended as a first choice antimycotic for topical application in the eye.