TREATMENT OF SUPERFICIAL MYCOSES IN THE TROPICS - WHITFIELDS OINTMENTVERSUS CLOTRIMAZOLE

Background. In tropical primary health care, essential drugs should be safe, effective, and as inexpensive as possible. To treat the very co mmon dermatophyte infections of the skin, one may use inexpensive Whit field's preparations, more expensive topical imidazole derivatives, or extremely expensive oral antifungals. Because a cream base is felt to be more appropriate than an ointment in tropical conditions, we wante d to compare the effectiveness of Whitfield's cream and a topical imid azole derivative in field conditions in the tropics. Methods. A double -blind trial was performed involving 153 patients with a dermatophyte infection of the skin in Karonga District, Northern Malawi, including 25 patients who were HIV-1-seropositive, comparing Whitfield's cream w ith clotrimazole cream. Results. 75 patients were treated with Whitfie ld's cream and 78 with clotrimazole cream for a period of 6 weeks. Cur e rates ranged from 80% to over 90% depending on the definition of cur e. If positive cultures after treatment were used as criterion for tre atment failure, six were found in each treatment group. One in each tr eatment failure group was an HIV-1-seropositive patient. Conclusions. The great majority of patients in the tropics with a dermatophyte infe ction of the skin can be cured with a topical antimycotic preparation and do not need expensive oral therapy. This also proved to be valid f or HIV-1-seropositive patients. Whitfield's cream and clotrimazole cre am are both very effective. The lower cost makes Whitfield's cream the treatment of choice in dermatophyte infections of the skin in tropica l primary health care.