ANTIFUNGAL AGENTS
Most fungal infections in the oral cavity are due to Candida species,
most commonly Candida albicans.
Where candidosis is related to dentures, denture hygiene instruction should be stressed. Non-metal dentures should be soaked regularly overnight in sodium hypochlorite 1% (Milton’s solution) and metal-containing dentures similarly in chlorhexidine 0.2% solution.
Nystatin and amphotericin (polyenes)
These agents attach to the fungal cell membrane and disrupt fluid and electrolyte permeability. They are not absorbed from the GI tract and hence act locally .
Dosage regimens for nystatin and amphotericin
Nystatin
Pastilles 100 000 units
Ointment/cream 100 000 units/g
Amphotericin
Oral suspension 100 mg/ml
Miconazole (an imidazole)
Similar action to the polyenes. Effective against some Gram-positive
bacteria such as Staph. aureus. More effective than polyenes in angular cheilitis due to possible mixed fungal/bacterial infection.
Available as oral gel, cream and in combination with hydrocortisone.
Oral gel (25 mg/ml) 5–10 ml held over area affected (after food) or applied to fitting surface of upper denture for the treatment of denture stomatitis (chronic erythematous candidosis).
Cream (2%) Apply to angles of lips 2–3 times daily. Cream or ointment (2%) with hydrocortisone (1%) Apply to angles of lips 2–3 times daily. May be useful for clearing long-standing angular cheilitis but should not be used for longer than 10 days.
Fluconazole (a triazole)
This systemically acting agent inhibits fungal enzymes concerned
with ergosterol synthesis. It appears to have low systemic toxicity.
Form Capsules (50 mg) and oral suspension (50 mg/5 ml). Dose 50 mg daily for 7–14 days. Higher doses will be required in immune compromised patients.
Cautions Avoid in renal disease, pregnancy and lactation, children.
Side effects Nausea, diarrhea and allergic manifestations are the most serious effects.
Main interactions are with antihistamines, oral hypoglycaemic agents and warfarin.
Itraconazole is another potent triazole antifungal agent.
