title: Antifungal effect of mouth rinses on oral Candida counts and salivary flow in treatment-naïve HIV-infected patients.
abstract: Oral candidiasis is a major problem in developing countries where antiretroviral therapy is available to a small percentage of the infected population. HIV patients are prone to xerostomia and predisposed to Candida infection. Preventing oral candidiasis is better than the frequent use of antifungals that may lead to the development of drug resistance. This study investigated the ability of commercial mouth rinses and sodium bicarbonate to reduce salivary Candida and to improve the saliva flow of HIV-positive patients. One hundred fifty HIV patients without oral candidiasis were examined for oral lesions initially and after 2, 4, and 12 weeks. Unstimulated saliva was collected; the volume was measured and cultured for yeasts. Subjects were provided with mouth rinses containing either benzydamine hydrochloride, benzydamine hydrochloride with chlorhexidine gluconate, triclosan with sodium fluoride, 5% sodium bicarbonate, or placebo and asked to rinse twice daily for 12 weeks. The effect of the mouth rinses and placebo on Candida counts and saliva flow was analyzed using analysis of variance (ANOVA). A total of 108 patients completed the trial, 35 missed appointments, 4 died, 2 developed oral candidiasis, and 1 herpetic lesion. Triclosan/fluoride decreased the Candida count more than the placebo (p = 0.005) while chlorhexidine/benzydamine hydrochloride (p = 0.001) and triclosan/fluoride mouthrinses (p = 0.002) increased the salivary flow during the initial 4 weeks. The most effective mouth rinse triclosan/fluoride decreased oral Candida counts and increased saliva flow. Studies are needed to determine the efficacy of these mouth rinses for the long-term prevention of clinical oral candidiasis in adult HIV-positive patients.
authors.affiliation: Division of Oral Microbiology, Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. mrudula.patel@wits.ac.za
authors.forename: Mrudula
authors.initials: M
authors.lastname: Patel
authors.forename: Jo-Anne
authors.initials: JA
authors.lastname: Shackleton
authors.forename: Maeve M
authors.initials: MM
authors.lastname: Coogan
authors.forename: Jacky
authors.initials: J
authors.lastname: Galpin
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000737:chemistry / Q000494:pharmacology; D001591:Benzydamine / Q000494:pharmacology; D002175:Candida / Q000187:drug effects* / Q000302:isolation & purification; D002176:Candida albicans; D002180:Candidiasis, Oral / Q000382:microbiology / Q000517:prevention & control*; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000494:pharmacology; D015169:Colony Count, Microbial; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000008:administration & dosage / Q000737:chemistry / Q000494:pharmacology; D012463:Saliva / Q000382:microbiology / Q000502:physiology; D012969:Sodium Fluoride / Q000494:pharmacology; D016896:Treatment Outcome; D014260:Triclosan / Q000494:pharmacology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D009067:Mouthwashes; D014260:Triclosan; D001591:Benzydamine; D012969:Sodium Fluoride; C010882:chlorhexidine gluconate; D002710:Chlorhexidine