Effects of amphotericin B gargles on oral colonization of Candida albicans in asthmatic patients on steroid inhalation therapy.
BACKGROUND
Early use of inhaled steroids is recommended for bronchial asthma. The side effects are rare, but oral discomfort and candidiasis are clinically important complications. Most previous studies reported that the use of spacer and water gargling was necessary to prevent oral complications. However, in some patients, this may fail to prevent such complications.


OBJECTIVE
To compare the effects of water gargling with those of amphotericin B, in the prevention of oral complications in asthmatics using inhaled steroids.


METHODS
Pharyngeal swab samples were obtained aseptically from the posterior pharyngeal wall of 128 asthmatics who have been using inhaled steroids (beclomethasone dipropionate) for more than 1 year. The amount of Candida albicans in cultured swabs was evaluated based on the following criteria: oral symptoms, method of gargling, dose of inhaled steroids, type of spacer and serum cortisol level.


RESULTS
The number of isolated C. albicans was significantly higher in asthmatics with oral symptoms than in those free of symptoms. It was also significantly higher in patients who gargled with water or 1,000 times dilution than in those who gargled with 100 or 50 times dilutions of amphotericin B. Moreover, it was significantly higher in patients with low levels of serum cortisol than in those with normal serum cortisol.


CONCLUSIONS
We demonstrated that at least in a subgroup of asthmatics using steroid inhalers, gargling with water or even weak concentrations of amphotericin B does not prevent colonization of the throat with C. albicans. This group at high risk of developing oral candidiasis should gargle with amphotericin B at concentrations higher than 100 times dilution that can prevent clinically detectable oral candidiasis.
Fukushima
C
C
Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan. fchizu-ngs@umin.ac.jp
Shimoda
T
T
Kawano
T
T
Tomari
S
S
Mitsuta
K
K
Obase
Y
Y
Matsuo
N
N
Matsuse
H
H
Kohno
S
S
D000284:Administration, Oral; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D002176:Candida albicans / Q000187:drug effects*; D002180:Candidiasis, Oral / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007564:Japan; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000494:pharmacology; D012138:Respiratory Therapy / Q000009:adverse effects* / Q000295:instrumentation; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*
D000935:Antifungal Agents; D009067:Mouthwashes; D013256:Steroids; D000666:Amphotericin B; D006854:Hydrocortisone