20 April 2022

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Oral Candidiasis and Treatment: Various Topical Antifungal Agents Compared

Lara Figini

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Oral candidiasis is mainly caused by C. albicans and is the most common oral fungal infection and is part of the superficial fungal infections. Varied are the causes of the onset of oral candidiasis, from the intake of antibiotics, glucocorticoids and immunosuppressants to the use of dental prostheses, immunodeficiency, organ transplantation and diabetes. More than 80% of HIV-infected patients, 15% to 71% of prosthetic patients, and 32.6% of patients with cancer or who are receiving or have received radiotherapy and chemotherapy have oral candidiasis. The most common etiologies for oral candidiasis in children include malnutrition and immunodeficiency. Oral candidiasis is also common in infants and is termed neonatal thrush. Treatment of oral candidiasis is mainly and preferably based on topical antifungal therapy. The most widely used topical antifungal drugs in the clinic are fluconazole, miconazole, clotrimazole, amphotericin B, itraconazole and nystatin.

Materials and methods
In a systematic review, published on OOO, March 2022, the authors compared the efficacy and safety of topical antifungal medications administered for the treatment of oral candidiasis in adults and children.
The authors performed a literature search of relevant articles, using major databases, published through December 2020. Randomized controlled trials comparing various topical antifungal agents were included. Clinical response and mycological cure rates were analyzed as primary goals. The incidence of adverse reactions and the relapse rate were investigated as secondary endpoints.

Results
In adults with oral candidiasis, fluconazole exhibited a better clinical response rate than clotrimazole, but a similar mycological cure rate. There was no significant difference in clinical response and mycological cure rates in treatments with fluconazole and amphotericin B or with itraconazole and clotrimazole. For immunocompetent patients, fluconazole showed better results than clotrimazole in terms of clinical response rate. For immunocompromised patients, clotrimazole and itraconazole showed similar clinical response and mycological cure rates, but the relapse rate with itraconazole was lower than that developed with clotrimazole. In infants, miconazole and nystatin exhibited similar clinical response rates, while miconazole exhibited a higher mycological cure rate.

Conclusions
From the data from this study, which must to be confirmed in other similar studies, it can be concluded that fluconazole and amphotericin B may be recommended as topical antifungal agents to treat oral candidiasis in adults.

Clinical implications
Based on the data of this meta-analysis for the treatment of oral candidiasis in adults, the dentist can rely on fluconazole-based mouthwashes and the oral suspension of amphotericin B, which at present appear to be the best drugs.
In immunocompromised adults, fluconazole-based mouthwash is recommended for topical antifungal treatment; in immunosuppressed patients, the oral solution of itraconazole is recommended. In children with oral candidiasis, miconazole oral gel is recommended. However, due to limited research and poor quality of evidence for some findings, more RCTs and higher quality RCTs are needed to validate these conclusions.

For additional information: Comparison of topical antifungal agents for oral candidiasis treatment: a systematic review and meta-analysis