Efficacy of antifungal agents in tissue conditioners in treating candidiasis.
Chronic atrophic candidiasis is prevalent in up to 72% of institutionalized geriatric populations and is causally associated with Candida albicans. Topical antifungal treatments are difficult to implement in some geriatric patients due to cognitive impairment, reduced motor dexterity and memory loss.


OBJECTIVE
This in vitro study incorporated antifungal agents into tissue conditioners to investigate the effectiveness of this method of drug delivery.


METHODS
Combinations of nystatin, fluconazole, itraconazole and Coe Soft, Viscogel, Fitt were tested at 1, 3, 5, 7, 9 and 11 wt/wt%, with and without sterilized saliva. 6 mm diameter cores were punched in Sabouraud plates pre-grown with standardized C. albicans. Antifungal agents plus tissue conditioner mixtures were injected into each core. Inhibition diameters were measured for 14 days.


RESULTS
Cores with only tissue conditioners acted as negative control and showed no significant inhibition activity (ANOVA, p > 0.05). Peak activity was between 65 to 89 hours; followed by a plateau. Itraconazole had greater fungicidal activity than fluconazole; while nystatin was found to have the least fungicidal activity (ANOVA, p < 0.05). The most effective concentration for nearly all combinations was 5% wt/wt (ANOVA, p < 0.05). Specimens with saliva showed greater antifungal activity than those without (t-test, p < 0.001). Itraconazole altered the physical properties of Viscogel hence this combination is not recommended for clinical use.


CONCLUSIONS
The treatment of chronic atrophic candidiasis by incorporation of antifungal drugs into tissue conditioners is efficacious. 5% wt/wt itraconazole mixed with Coe Soft or Fitt is recommended for clinical study where compliance of patient or care giver cannot be relied upon. Peak antifungal activity at 3 days suggests that mixtures prepared for clinical study may be replaced soon after this time for maximum effectiveness.
Chow
C K
CK
Faculty of Dentistry, University of Toronto, Ontario, Canada. clara.chow@utoronto.ca
Matear
D W
DW
Lawrence
H P
HP
D000180:Acrylic Resins; D000368:Aged; D000704:Analysis of Variance; D000935:Antifungal Agents / Q000008:administration & dosage*; D002176:Candida albicans / Q000187:drug effects*; D002180:Candidiasis, Oral / Q000188:drug therapy*; D016321:Dental Care for Aged / Q000379:methods*; D003822:Denture Liners; D004338:Drug Combinations; D016503:Drug Delivery Systems; D015725:Fluconazole / Q000008:administration & dosage; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage; D008768:Methylmethacrylates; D008826:Microbial Sensitivity Tests; D009761:Nystatin / Q000008:administration & dosage; D010795:Phthalic Acids; D018709:Statistics, Nonparametric; D013282:Stomatitis, Denture / Q000188:drug therapy / Q000382:microbiology; D014016:Tissue Conditioning, Dental
D000180:Acrylic Resins; D000935:Antifungal Agents; D004338:Drug Combinations; D008768:Methylmethacrylates; D010795:Phthalic Acids; D009761:Nystatin; C043685:Coe Comfort; D017964:Itraconazole; C076423:Coe Super-Soft; D015725:Fluconazole; C009931:poly(ethylmethacrylate)