Oral candidiasis is a common opportunistic infection that requires knowledge of the
various clinical presentations and management strategies for successful treatment.
Numerous local and systemic factors contribute to the development of candidiasis,
and the infections can range from superficial mucocutaneous overgrowths to invasive
bloodstream infections with a high mortality rate. In addition to Candida albicans, various fungal strains have been isolated from the oral cavity, including C. tropicalis, C. glabrata, C. krusei, and many others. Antifungal agents are available in various forms, each with differing
indications, dosing regimens, adverse effects, and drug interactions. Some antifungal
agents are available as oral suspensions, pastilles, or creams, whereas others are
administered systemically in capsule or intravenous form. This review describes the
various presentations of oral candidiasis and the diagnostic methods and treatment
alternatives, with a specific focus on pharmacologic management. Spectra of activity,
mechanisms of action, adverse reactions, drug interactions, and dosing regimens are
explored in the context of both topical and systemic pharmacotherapy used to treat
candidiasis. Polyenes (nystatin, amphotericin B); azoles (ketoconazole, miconazole,
clotrimazole, fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole);
and echinocandins (caspofungin, micafungin, anidulafungin) are discussed. Novel approaches
in antifungal therapy with the use of probiotics are also reviewed.
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References
- Pathology and clinical correlates in oral candidiasis and its variants: a review.Oral Dis. 2000; 6: 85-91
- Clinical and microbiological diagnosis of oral candidiasis.J Clin Exp Dent. 2013; 5: 279-286
- Oral candidiasis.Postgrad Med J. 2002; 78: 455-459
- Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options.J Med Microbiol. 2013; 62: 10-24
- Molecular epidemiology of the global and temporal diversity of Candida albicans.Clin Infect Dis. 1999; 29: 1220-1225
- Candida albicans: a review of its history, taxonomy, epidemiology virulence attributes, and methods of strain differentiation.Int J Oral Maxillofac Surg. 1996; 25: 136-144
- Comparison of the epidemiology, drug resistance mechanisms, and virulence of Candida dubliniensis and Candida albicans.FEMS Yeast Res. 2004; 4: 369-376
- Molecular characterization of Candida spp. isolated from the oral cavities of patients from diverse clinical settings.Oral Microbiol Immunol. 2002; 17: 44-49
- Oral candidiasis: a review.Int J Pharm Pharm Sci. 2010; 2: 36-41
- Candida glabrata, an emerging oral opportunistic pathogen.J Dent Res. 2007; 86: 204-215
- AIDS-defining neoplasm prevalence in a cohort of HIV-infected patients, before and after highly active antiretroviral therapy.Ethn Dis. 2008; 18 (S2-189-194)
- Denture plaque—past and recent concerns.J Dent. 1998; 26: 299-304
- Kinetics of oral colonization by Candida spp. during topical corticotherapy for oral lichen planus.J Oral Pathol Med. 2014; 43: 570-575
- Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids: effect of drug, dose, and device.Respir Med. 2016; 120: 54-63
- Xerostomia in the geriatric patient: causes, oral manifestations, and treatment.Compend Contin Educ Dent. 2016; 37 (quiz 312): 306-311
- Viral, bacterial, and fungal infections of the oral mucosa: types, incidence, predisposing factors, diagnostic algorithms, and management.Periodontol 2000. 2019; 80: 148-176
- Oral fungal infections.Dent Clin North Am. 2005; 49: 49-65
- Median rhomboid glossitis.in: Alanis L.R.A. Oral Candidosis: Physiopathology, Decision Making, and Therapeutics. Springer-Verlag, Berlin, Heidelberg, Germany2015: 65-67
- Oral candidiasis.Clin Dermatol. 2016; 34: 487-494
- Fourth Elsevier, Inc., St. Louis, MO2016
- Oral mucosal fungal infections.Periodontol 2000. 2009; 49: 39-59
- Chronic hyperplastic candidosis/candidiasis (candidal leukoplakia).Crit Rev Oral Biol Med. 2003; 14: 253-267
- Oral fungal infections: an update for the general practitioner.Aust Dent J. 2010; 55: 48-54
- Oral candidosis.Clin Dermatol. 2000; 18: 553-562
- Oral candidosis and the therapeutic use of antifungal agents in dentistry.Aust Dent J. 2005; 50: S36-S39
- Chronic mucocutaneous candidiasis.Pediatr Infect Dis J. 2001; 20: 197-206
- Diagnosis and management of oral candidiasis.Otolaryngol Clin North Am. 2011; 44: 231-240
- The CDx brush biopsy and the diagnosis of oral candidiasis.Dent Today. 2007; 26 (96, 98-99)
- Comparison of three test methods used for the diagnosis of candidiasis.Eur J Oral Sci. 1994; 102: 295-298
- Efficacy of antifungal drugs in the treatment of oral candidiasis: a Bayesian network meta-analysis.J Prosthet Dent. 2020; (Mar 10;S0022-3913(20)30076-7Epub ahead of print)https://doi.org/10.1016/j.prosdent.2019.12.025
- Amphotericin B formulations: a comparative review of efficacy and toxicity.Drugs. 2013; 73: 919-934
- Antifungal agents: spectrum of activity, pharmacology, and clinical indications.Infect Dis Clin North Am. 2016; 30: 51-83
- Isavuconazole: a new option for the management of invasive fungal infections.Ann Pharmacother. 2015; 49: 825-842
- Iatrogenic QT Abnormalities and fatal arrhythmias: mechanisms and clinical significance.Curr Cardiol Rev. 2009; 5: 166-176
- Dental treatment of patients with long QT syndrome.J Am Dent Assoc. 2006; 137: 630-637
- Association of QT-prolonging medication use in CKD with electrocardiographic manifestations.Clin J Am Soc Nephrol. 2017; 12: 1409-1417
- Review and management of the dental patient with long QT syndrome (LQTS).Anesth Prog. 2009; 56: 42-48
- Antifungal therapy: new and evolving therapies.Semin Respir Crit Care Med. 2020; 41: 158-174
- Antifungal agents: in vitro susceptibility testing, pharmacodynamics, and prospects for combination therapy.Eur J Clin Microbiol Infect Dis. 2004; 23: 256-270
- Learning the ABC of oral fungal drug resistance.Mol Oral Microbiol. 2015; 30: 425-437
- Antifungal therapy with an emphasis on biofilms.Curr Opin Pharmacol. 2013; 13: 726-730
- Posaconazole.Drugs. 2005; 65: 1553-1567
- Caspofungin: a review of its use in oesophageal candidiasis, invasive candidiasis and invasive aspergillosis.Drugs. 2003; 63: 2235-2263
- Micafungin: a new echinocandin.Clin Infect Dis. 2006; 42: 1171-1178
- Pharmacology of systemic antifungal agents.Clin Infect Dis. 2006; 43 (Available at:)
- Hepatic uptake of the novel antifungal agent caspofungin.Drug Metab Dispos. 2005; 33: 676-682
- Update on echinocandin antifungals.Semin Respir Crit Care Med. 2008; 29: 211-219
- New strategic insights into managing fungal biofilms.Front Microbiol. 2015; 6: 1077
- Probiotics as antifungals in mucosal candidiasis.Clin Infect Dis. 2016; 62: 1143-1153
- Probiotic lactobacilli inhibit early stages of Candida albicans biofilm development by reducing their growth, cell adhesion, and filamentation.Appl Microbiol Biotechnol. 2016; 100: 6415-6426
- Purpurin suppresses Candida albicans biofilm formation and hyphal development.PLoS One. 2012; 7: e50866
- Probiotics as a prophylaxis to prevent oral candidiasis in patients with Sjogren's syndrome: a double-blinded, placebo-controlled, randomized trial.Rheumatol Int. 2020; 40: 873-879
- A multispecies probiotic reduces oral candida colonization in denture wearers.J Prosthodont. 2015; 24: 194-199
- Evaluation of efficacy of probiotics in prevention of Candida colonization in a PICU-a randomized controlled trial.Crit Care Med. 2013; 41: 565-572
- Effects of probiotic bacteria on Candida presence and IgA anti-Candida in the oral cavity of elderly.Braz Dent J. 2012; 23: 534-538
- Cheese supplemented with probiotics reduced the Candida levels in denture wearers—RCT.Oral Dis. 2017; 23: 919-925
- Efficacy and safety of probiotics in the treatment of Candida-associated stomatitis.Mycoses. 2014; 57: 141-146
- The mechanism of action of probiotics.Curr Opin Gastroenterol. 2007; 23: 679-692
- Oral candidiasis: a disease of opportunity.J Fungi. 2020; 6: 15
- Candidiasis drug discovery and development: new approaches targeting virulence for discovering and identifying new drugs.Expert Opin Drug Discov. 2013; 8: 1117-1126
ClinicalTrials.gov. Available at: https://clinicaltrials.gov/. Accessed July 9, 2020.
- Fungal cell wall: emerging antifungals and drug resistance.Front Microbiol. 2019; 10: 2573
- In vitro activity of APX001 A (Manogepix) and comparator agents against 1,706 fungal isolates collected during an international surveillance program in 2017.Antimicrob Agents Chemother. 2019; 63 (e00840-19)
- Oropharyngeal candidiasis: fungal invasion and epithelial cell responses.PLoS Pathog. 2017; 13e1006056
Article info
Publication history
Published online: September 06, 2020
Accepted:
August 11,
2020
Received in revised form:
July 17,
2020
Received:
May 25,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
