Mucosal Candidiasis Treatment & Management
- Author: Crispian Scully, MD, PhD, MDS, CBE, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed(HC), Dr(HC), ; Chief Editor: William D James, MD more...
Medical Care
Attention to the underlying cause helps avoid prolonged or repeated courses of treatment. If antibiotics or corticosteroids (oral or inhaled) are the probable cause, reducing the dose or changing the treatment may help. Resistance of fungi to polyenes is rare, but some Candida species, such as Candida glabrata and Candida krusei, are innately less susceptible to azoles, and Candida albicans can acquire azole resistance).[7]
Intermittent or prolonged topical antifungal treatment may be necessary when the underlying cause is unavoidable or incurable.
In patients with severe immunosuppression, prevention of colonization and infection is the goal because the oropharyngeal region may be the primary source of initial colonization and allows subsequent spread of the infection. Individuals at greatest risk of fungal infection, such as patients with HIV disease and people receiving cancer chemotherapy, immunosuppressive therapy, or prolonged antibiotic therapy, may need prophylactic antifungals. In HIV infection, topical agents often initially control the infection until the increasing immune defect necessitates systemic agents. Topical antifungal agents are available as rinses, tablets, vaginal tablets, and creams. Oral rinses are useful for patients with dry mouth who may have difficulty dissolving tablets. Some oral products are sweetened with sugar, predisposing patients to dental caries.
Also see the following clinical guideline summaries:
Denture plaque often contains Candida species. To prevent denture-induced stomatitis, denture cleansing that includes removal of candidal organisms is a necessary and important factor. Cleansers can be divided into groups according to their primary components: alkaline peroxides, alkaline hypochlorites, acids, disinfectants, and enzymes. Yeast lytic enzymes and proteolytic enzymes are the most effective against the infection. Denture soak solution containing benzoic acid completely eradicates C albicans from the denture surface as it is taken up into the acrylic resin and eliminates the organism from the internal surface of the prosthesis. An oral rinse containing 0.12% chlorhexidine gluconate results in complete elimination of the presence of C albicans on the acrylic resin surface of the denture and in reduction of palatal inflammation. A protease-containing denture soak (alkalize protease) also effectively removes denture plaque, especially when combined with brushing.
Chlorhexidine oral rinses also may be of some benefit in the control of oral candidosis. It is important to note that clinical cure is not synonymous with mycologic cure.
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