ORAL CANDIDIASIS AND CURRENT TRENDS IN ITS RATIONAL PHARMACOTHERAPY

Abstract

Oral candidiasis is one of the most common opportunistic infections caused by C. albicans and other species of the genus Candida. Clinical recognition of oral lesions is the basis for the diagnosis of oral candidiasis, and the isolation of Candida in pure culture and susceptibility testing for antifungal drugs help if the infection is recurrent or caused by species other than C. albicans. The aim of the work is to analyze the literature data on modern approaches to the etiotropic therapy of oral candidiasis depending on the form and severity of the process.Treatment of oral candidiasis is based on the diagnosis of the type of oral candidiasis, correction of risk factors or diseases, as well as the use of the most appropriate antifungal drugs. The three major families include the most commonly used antifungal drugs: polyenes (amphotericin B and nystatin), echinocandins (anidulafungin, caspofungin, and micafungin), and azoles (fluconazole, itraconazole, etc). Antifungal treatment of oral candidiasis can be performed locally or systemically. Topical therapy with nystatin and miconazole remains the recommended treatment for oral candidiasis due to its high efficacy, low cost and minimal number of side effects. Oral fluconazole is recommended for the treatment of moderate and severe oral candidiasis. At a disease refractory to fluconazole, itraconazole, posaconazole, and voriconazole can be appointed. Among the advantages of echinocandins for the treatment of severe and resistant forms of oral candidiasis is their antibiofilm activity and a long-term post-antifungal effect. Other therapeutic alternatives include the use of terpenes, probiotics, peptides, antibodies, cytokines or substances that prevent the transition of C. albicans from commensal to pathogen. Therefore, topical treatment with nystatin or miconazole and systemic treatment with oral fluconazole has shown similar efficacy. In case of treatment failures or recurrent infections, new antifungal agents with old and new mechanisms of action should be expected.

Keywords

• oral candidiasis
• treatment
• antifungal drugs.