Oral candidiasis prevention in transplantation patients: a comparative study.
OBJECTIVE
Oral candidiasis occurs commonly in haematopoietic -stem cell transplantation (HSCT) patients carrying a risk of systemic candidemia and mortality. The aim of this pilot study was to design an effective protocol that prevents oral candidiasis and improves tolerability.


METHODS
A prospective, randomized, longitudinal study with two treatment groups, (A) chlorhexidine (CHX) and (B) CHX combined with medium-dose amphotericin B (AMB), was performed. The investigators were blinded to the treatment arm.


RESULTS
No clinical signs of oral candidiasis were observed in any of the 20 patients. All patients experienced neutropenia and were treated with antibiotics. The duration of antibiotic treatment was longer in group A than that in group B. The difference in systemic anti-fungal treatment was insignificant. Compliance was achieved in both groups, although tolerability was better in group A than that in group B.


CONCLUSIONS
Effective oral anti-fungal prevention based on topical AMB was suggested. CHX mouthwash was also suggested to be effective as a single topical agent for the prevention of oral candidiasis in HSCT patients. The combination of topical CHX and medium-dose AMB-prophylactic protocol may achieve the same level of candidial prevention with better tolerability than that by AMB alone. More research is warranted.
Elad
Sharon
S
Department of Oral Medicine, School of Dental Medicine, Hebrew University-Hadassah, Jerusalem, Isreal.
Wexler
Alon
A
Garfunkel
Adi A
AA
Shapira
Michael Y
MY
Bitan
Menachem
M
Or
Reuven
R
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002180:Candidiasis, Oral / Q000517:prevention & control*; D002710:Chlorhexidine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009067:Mouthwashes; D010865:Pilot Projects; D011446:Prospective Studies
D000935:Antifungal Agents; D009067:Mouthwashes; D000666:Amphotericin B; D002710:Chlorhexidine