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Author Spotlight: Oral Candida Diagnosis to Advance Clinical Treatment Regimen for pSS Patients
Published on: March 1, 2024
Candidiasis (oropharyngeal)
1King's College London at Guy's, King's and St Thomas's Dental Institute, London, UK.
Introduction:
Candida is a fungus present in the mouths of up to 60% of healthy people, but overt infection is associated with immunosuppression, diabetes, broad-spectrum antibiotics, and corticosteroid use. In most people, untreated candidiasis persists for months or years unless associated risk factors are treated or eliminated. In neonates, spontaneous cure of oropharyngeal candidiasis usually occurs after 3 to 8 weeks.
Methods And Outcomes:
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent and treat oropharyngeal candidiasis in: adults undergoing treatments that cause immunosuppression; infants and children; people with dentures; and people with HIV infection? Which antifungal treatments reduce the risk of acquiring resistance to antifungal drugs? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results:
We found 47 RCTs or systematic reviews of RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions:
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antifungals (absorbed, partially or topically absorbed, or non-absorbed; for example, imidazole [ketoconazole, clotrimazole, toiconazole, miconazole], polyene [amphotericin B, nystatin], triazole [fluconazole, itraconazole], melaleuca and posaconazole), intermittent or continuous prophylaxis, or treatment, and denture hygiene.
Insights
This systematic review evaluates interventions for oropharyngeal candidiasis, finding various antifungal treatments and denture hygiene effective. It assesses treatments for specific populations, including immunocompromised adults and infants.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Evidence-Based Medicine
Background:
- Oropharyngeal candidiasis (OPC) is a fungal infection often linked to immunosuppression, diabetes, and medication use.
- While common in healthy individuals, OPC can persist without addressing underlying risk factors.
- Neonatal OPC typically resolves spontaneously within 3-8 weeks.
Purpose of the Study:
- To systematically review interventions for preventing and treating OPC in diverse patient groups.
- To evaluate antifungal treatments for their efficacy and impact on antifungal resistance.
- To assess interventions for adults with treatment-induced immunosuppression, infants, children, denture wearers, and individuals with HIV.
Main Methods:
- Systematic review of 47 randomized controlled trials (RCTs) and systematic reviews of RCTs.
- Searches conducted across major databases (Medline, Embase, Cochrane Library) up to July 2013.
- Inclusion of safety alerts from regulatory agencies (FDA, EMA, MHRA).
Main Results:
- The review identified 47 relevant studies meeting inclusion criteria.
- A GRADE evaluation was performed to assess the quality of evidence for interventions.
- Data on effectiveness and safety of various antifungals and denture hygiene were compiled.
Conclusions:
- Various antifungal agents, including imidazole, polyene, and triazole classes, demonstrate effectiveness in treating OPC.
- Intermittent or continuous prophylaxis and treatment strategies were evaluated.
- Denture hygiene is highlighted as a relevant intervention for managing OPC.
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