Oral candidiasis prevention in transplantation patients: a comparative study

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.

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.

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.

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.