Oral candidiasis is a significant infection in patients being treated with chemotherapy
and radiotherapy for cancer, and in patients who are immunocompromised because of
HIV infection and AIDS. Candida albicans is the most common fungal pathogen and has developed an extensive array of putative
virulent mechanisms that allows successful colonization and infection of the host
under suitable predisposing conditions. The purpose of this review of the literature
was to assess the effectiveness of interventions for the prevention of oral candidiasis
in immunocompromised patients and in patients treated for cancer with radiotherapy
and/or chemotherapy. These patient categories were selected because they have been
the topic of published randomized controlled clinical trials. The studies reviewed
provide strong evidence that oral candidiasis is associated with greater morbidity
and mortality in these populations, which substantiates the aggressive treatment and
prophylaxis of this infection. The literature supports the recommendation that systemically
applied antifungal drugs have the greatest efficacy for the treatment of oral candidiasis
in cancer and immunocompromised patients; however, these therapies must be prescribed
with a thorough assessment for the risk for developing drug-induced toxicities. Guidelines
on the prevention of drug-resistant oral candidiasis in these patients are not available
and require elucidation. Further studies are required to expand the knowledge base
of evidence-based antifungal therapies in a wider variety of immunocompromised patients
and conditions, such as Sjögren’s syndrome, diabetes, and denture wearers. Additional
exploration is needed to determine which antifungal drug formulation, dose, and method
of delivery is preferable for the type of fungal infection and the underlying etiology.
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