Skip to main content Accessibility help

In vitro activities of fluconazole, itraconazole and voriconazole against otomycotic fungal pathogens

  • G Yenişehirli (a1), Y Bulut (a1), M Güven (a2) and E Günday (a1)



To determine the causative pathogens of otomycosis, and to evaluate the in vitro activity of antifungal agents against these pathogens.

Materials and methods:

A total of 96 fungal isolate were taken from 92 patients suspected of otomycosis. The in vitro activity of fluconazole, itraconazole and voriconazole against otomycotic pathogens was tested using the E-test method.


The most common pathogen was Aspergillus fumigatus (40.6 per cent), followed by A niger (35.4 per cent), A flavus (12.5 per cent) and Candida albicans (11.5 per cent). All Aspergillus species were found to be resistant to fluconazole (minimum inhibitory concentration ≥256 µg/ml). The mean minimum inhibitory concentrations of voriconazole for A fumigatus, A niger, A flavus and C albicans were significantly lower than those of itraconazole for the same pathogens.


This study found that the most common otomycotic fungal pathogen was A fumigatus, and that voriconazole had more potent in vitro activity than itraconazole against all Aspergillus species as well as against C albicans.


Corresponding author

Address for correspondence: Dr Gülgün Yenişehirli, Gaziosmanpaşa University, Faculty of Medicine, Department of Microbiology and Clinical Microbiology, 60100 Tokat, Turkey. Fax: +90 356 2133176 E-mail:


Hide All
1 Kaur, R, Mittal, N, Kakkar, M, Aggarwal, AK, Mathur, MD. Otomycosis: a clinicomycologic study. Ear Nose Throat J 2000;79:606–9
2 Lucente, FE. Fungal infections of the external ear. Otolaryngol Clin North Am 1993;26:9951006
3 Vennewald, I, Wollina, U. Cutaneous infections due to opportunistic molds: uncommon presentations. Clin Dermatol 2005;23:565–71
4 Denning, DW, Venkateswarlu, K, Oakley, KL, Anderson, MJ, Manning, NJ, Stevens, DA et al. Itraconazole resistance in Aspergillus fumigatus. Antimicrob Agents Chemother 1997;41:1364–8
5 Denning, DW, Radford, SA, Oakley, KL, Hall, L, Johnson, EM, Warnock, DW. Correlation between in-vitro susceptibility testing to itraconazole and in-vivo outcome of Aspergillus fumigatus infection. J Antimicrob Chemother 1997;40:401–14
6 Rex, JH, Rinaldi, MG, Pfaller, MA. Resistance of Candida species to fluconazole. Antimicrob Agents Chemother 1995;39:18
7 Kombila, M, Gomez de Diaz, M, de Bievre, C, Crepet, G, Debrie, JC, Belembaogo, E et al. Fungal otitis in Libreville. Study of 83 cases. Bull Soc Pathol Exot Filiales 1989;82:201–7
8 Ozcan, KM, Ozcan, M, Karaarslan, A, Karaarslan, F. Otomycosis in Turkey: predisposing factors, aetiology and therapy. J Laryngol Otol 2003;117:3942
9 Kaya, AD, Kiraz, N. In vitro susceptibilities of Aspergillus spp. causing otomycosis to amphotericin B, voriconazole and itraconazole. Mycoses 2007;50:447–50
10 Phillips, P, Bryce, G, Shepherd, J, Mintz, D. Invasive external otitis caused by Aspergillus. Rev Infect Dis 1990;12:277–81
11 Stodulski, D, Kowalska, B, Stankiewicz, C. Otogenic skull base osteomyelitis caused by invasive fungal infection. Case report and literature review. Eur Arch Otorhinolaryngol 2006;263:1070–6
12 National Committee for Clinical Laboratory Standards. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi. Approved standard. NCCLS Document M38-A. Villanova, Pennsylvania: Clinical and Laboratory Standards Institute, 2002
13 Espinel-Ingroff, A, Rezusta, A. E-test method for testing susceptibilities of Aspergillus spp. to the new triazoles voriconazole and posaconazole and to established antifungal agents: comparison with NCCLS broth microdilution method. J Clin Microbiol 2002;40:2101–7
14 Pfaller, JB, Messer, SA, Hollis, RJ, Diekema, DJ, Pfaller, MA. In vitro susceptibility testing of Aspergillus spp.: comparison of E-test and reference microdilution methods for determining voriconazole and itraconazole MICs. J Clin Microbiol 2003;41:1126–9
15 Pfaller, MA, Diekema, DJ, Messer, SA, Boyken, L, Hollis, RJ. Activities of fluconazole and voriconazole against 1,586 recent clinical isolates of Candida species determined by Broth microdilution, disk diffusion, and E-test methods: report from the ARTEMIS Global Antifungal Susceptibility Program, 2001. J Clin Microbiol 2003;41:1440–6
16 Sheehan, DJ, Hitchcock, CA, Sibley, CM. Current and emerging azole antifungal agents. Clin Microbiol Rev 1999;12:4079
17 Pfaller, MA, Messer, SA, Hollis, RJ, Jones, RN, SENTRY Participants Group. Antifungal activities of posaconazole, ravuconazole, and voriconazole compared to those of itraconazole and amphotericin B against 239 clinical isolates of Aspergillus spp. and other filamentous fungi: report from SENTRY Antimicrobial Surveillance Program, 2000. Antimicrob Agents Chemother 2002;46:1032–7
18 Messer, SA, Jones, RN, Fritsche, TR. International surveillance of Candida spp. and Aspergillus spp.: report from the SENTRY Antimicrobial Surveillance Program (2003). J Clin Microbiol 2006;44:1782–7
19 Verweij, PE, Te Dorsthorst, DT, Rijs, AJ, De Vries-Hospers, HG, Meis, JF. Nationwide survey of in vitro activities of itraconazole and voriconazole against clinical Aspergillus fumigatus isolates cultured between 1945 and 1998. J Clin Microbiol 2002;40:2648–50
20 Dannaoui, E, Persat, F, Monier, MF, Borel, E, Piens, MA, Picot, S. In vitro susceptibility of Aspergillus spp. isolates to amphotericin B and itraconazole. J Antimicrob Chemother 1999;44:553–5
21 Pfaller, MA, Boyken, L, Hollis, RJ, Messer, SA, Tendolkar, S, Diekema, DJ. In vitro susceptibilities of clinical isolates of Candida species, Cryptococcus neoformans, and Aspergillus species to itraconazole: global survey of 9,359 isolates tested by clinical and laboratory standards institute broth microdilution methods. J Clin Microbiol 2005;43:3807–10
22 Mallié, M, Bastide, JM, Blancard, A, Bonnin, A, Bretagne, S, Cambon, M et al. In vitro susceptibility testing of Candida and Aspergillus spp. to voriconazole and other antifungal agents using E-test: results of a French multicentre study. Int J Antimicrob Agents 2005;25:321–8
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed