Effiectiveness of Etiotropic Therapy in Patients with Chronic Recurrent Oral Candidiasis: a Randomized Controlled Clinical Trial

Abstract

Background. Effective treatment of oral candidiasis is especially relevant due to the increase in patients with recurrent fungal lesions of the oral cavity caused by the growing number of Candidaspp. strains refractory to antimycotic drugs. The paper presents the results of the study on the clinical efficacy of etiotropic therapy in patients with chronic recurrent course of oral candidiasis.Objective. To assess the effectiveness of etiotropic therapy in patients with chronic recurrent oral candidiasis.Methods. A randomized controlled clinical trial was conducted in 56 patients with chronic recurrent oral candidiasis aged 45 to 74 years. Examination and treatment of patients was performed at the Department of Dentistry of Volgograd State Medical University and at Volgograd Regional Clinical Dental Polyclinic (Volgograd, Russia). Study timeline: September 2020 — November 2022. Patients were divided into 2 groups depending on the antimycotic drug used: in the main group, patients took voriconazole, in the control group — fluconazole. In addition to etiotropic therapy, patients of both groups were prescribed complex treatment aimed at stimulating the immune protection of the body, restoring vitamin and mineral deficiency, and correcting the imbalance of the oral ecosystem. The patients underwent local symptomatic therapy: antiseptic treatment with 0.06% chlorhexidine bigluconate solution, anesthesia with 15% lidocaine gel, and 3.44% retinol oil solution to stimulate epithelization. Oral sanitation and professional hygiene were recommended for patients to prevent oral candidiasis. In order to restore chewing function, patients were referred to prosthodontic treatment. The main reference point of the study was to assess the effectiveness of the therapy, both by clinical criteria and by evaluating the results of bacterial culture test in order to record the quantitative, species and susceptibility profile of Candidaspp. strains in 3 weeks, 6 and 12 months after the end of treatment. Analysis and statistical processing of the obtained data were performed using Excel program to MS Windows 10 (Microsoft Corp., USA).Results. The most common pathogenic agent of chronic recurrent forms of oral candidiasis is C. albicans (69.6%), followed by C. non-albicans species — C. krusei (10.7%), C. tropicalis (10.7%) and C. glabrata (8.9%). Analysis of the quantitative characteristics of Candidaspp. using bacterial culture test revealed a high and moderate number of Candidaspp. CFU in most clinical isolates before treatment, and no such cases in patients of the main group after treatment. The susceptibility test of yeast fungi to fluconazole and itraconazole showed the presence of isolates with dose-dependent susceptibility, and the resistance of individual samples C. krusei to fluconazole and C. glabrata (16.7% and 60%, respectively) and to itraconazole (33.3% and 100%, respectively). All Candidaspp. isolates were found to be highly susceptible to voriconazole. The efficacy of the combined treatment of an episode with voriconazole is 95.4%. Continued suppressive therapy with voriconazole resulted in relapse prevention in 98.3% of patients. Etiotropic therapy with voriconazole provided a stable clinical effect (92.7%) after a year of follow-up.Conclusion. The results of the study confirm the effectiveness of etiotropic therapy with voriconazole for chronic oral candidiasis complicated by a recurrent course, especially in case of detected C. non-albicans or fluconazole- and itraconazole-resistant C. albicans, or if it is impossible to identify the pathogenic agent.