Oral candidal infections and antimycotics.
The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidoses. One form of the latter presents classically as a white lesion of "thrush" and is usually easily diagnosed and cured. Nonetheless, a minority of these lesions appears in new guises such as erythematous candidosis, thereby confounding the unwary clinician and complicating its management. Despite the availability of several effective antimycotics for the treatment of oral candidoses, failure of therapy is not uncommon due to the unique environment of the oral cavity, where the flushing effect of saliva and the cleansing action of the oral musculature tend to reduce the drug concentration to sub-therapeutic levels. This problem has been partly circumvented by the introduction of the triazole agents, which initially appeared to be highly effective. However, an alarming increase of organisms resistant to the triazoles has been reported recently. In this review, an overview of clinical manifestations of oral candidoses and recent advances in antimycotic therapy is given, together with newer concepts, such as the post-antifungal effect (PAFE) and its possible therapeutic implications.
Ellepola
A N
AN
Division of Oral Bio-sciences, Faculty of Dentistry, University of Hong Kong, Prince Philip Dental Hospital, Hong Kong.
Samaranayake
L P
LP
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy; D000666:Amphotericin B / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects; D002180:Candidiasis, Oral / Q000145:classification / Q000188:drug therapy*; D002710:Chlorhexidine / Q000627:therapeutic use; D003022:Clotrimazole / Q000627:therapeutic use; D025141:Drug Resistance, Fungal; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000627:therapeutic use; D007654:Ketoconazole / Q000627:therapeutic use; D008825:Miconazole / Q000627:therapeutic use; D009055:Mouth / Q000502:physiology; D009761:Nystatin / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000188:drug therapy; D012463:Saliva / Q000502:physiology; D017211:Treatment Failure; D014230:Triazoles / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use
D000891:Anti-Infective Agents, Local; D000935:Antifungal Agents; D014230:Triazoles; D009761:Nystatin; D017964:Itraconazole; D008825:Miconazole; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine; D003022:Clotrimazole; D002710:Chlorhexidine; D007654:Ketoconazole