title: Oral mucositis caused byCandida glabratabiofilms: failure of the concomitant use of fluconazole and ascorbic acid.
abstract: OBJECTIVE
  Candida glabratais becoming one of the most prevalent pathogenic yeasts in cases of oral diseases. Mucositis is an recurrent oral infection in immunocompromised patients, and the actual guidelines recommend the use of fluconazole (Flu) for many cases. However, the azole resistance byC. glabratais renowned, causing a reduced therapeutic response, especially when it occurs in biofilms. In this study, we performed anin vitroevaluation of an alternative pharmacotherapy forC. glabratabiofilm infections, combining ascorbic acid (AA) with Flu. AA is recognized for degrading β-glucans, an important compound of the biofilm matrices, which prevent drug diffusion.
  
  
  METHODS
  Routine clinical 30 or 40 mg/l doses of Flu were applied toC. glabratabiofilms simultaneously with 200 or 300 mg/l of AA.
  
  
  RESULTS
  The results showed that this combination effectively promoted the degradation of the biofilm network, but unfortunately, also stimulated the growth of the yeasts population due to release of several glucose monomers during β-glucans hydrolysis.
  
  
  CONCLUSIONS
  AA lead to the hydrolysis of the β-glucans of the matrix, liberating glucose molecules which are used as carbon souce by the yeasts, thus suppressing the desired antifungal effect of the drug combination with Flu.
  
  
  CONCLUSIONS
  Unlike to what happens in treatment of bacterial infection, AA should not be used together with Flu in the treating oral mucositis caused byCandida.
authors.affiliation: Centre of Biological Engineering (CEB), Laboratório de Investigação em Biofilmes Rosário Oliveira (LIBRO), University of Minho, Braga, Portugal.
authors.forename: Célia F
authors.initials: CF
authors.lastname: Rodrigues
authors.affiliation: Centre of Biological Engineering (CEB), Laboratório de Investigação em Biofilmes Rosário Oliveira (LIBRO), University of Minho, 4710-057 Braga, Portugal.
authors.forename: Mariana
authors.initials: M
authors.lastname: Henriques
keywords: Candida glabrata; ascorbic acid; biofilm matrix; fluconazole; infection; resistance