The In vitro and In vivo Antifungal Activities of Akhizunber, and Therapeutic Effects Against Biofilm Forming Candida Isolates in Combination with Fluconazole

Abstract

Recent studies indicate that the incidence of oral mucosal diseases has increased worldwide due to predisposing factors, including unbalanced dietary intake, prolonged therapy with antibiotics, bad habits, and environmental pollution. Akhizunber, a novel herbal preparation delivered for the treatment of oral mucosal ulcers, was prepared from the medicinal herbs of Achillea asiatica Serg, leaves of Juniperus sabina L, and roots of Bergenia crassifolia (L) Fritsch in a ratio of 2:1:2, immersed for 1 week in 40% ethanol. Previous studies revealed effectiveness of Akhizunber in the treatment of oral aphthous stomatitis. Simultaneously, Akhizunber showed in vitro inhibitory effect on development of Candida albicans. For those reasons, we aimed to study effect of Akhizunber in the treatment of oral candidiasis. First, we studied in vitro effects of Akhizunber on biofilm formation by C. albicans on type I collagen cell desks, precoated with mucin. In a clinical study, a total of 50 patients diagnosed with oral candidiasis were participated. In the experimental group, oral administration of azole antifungal agents combined with local application of Akhizunber was performed. In biofilms grown under exposure to higher concentrations of Akhizunber, inhibitory effects on formation of hyphae from yeast cells were observed. The local treatment of oral lesions with Akhizunber combined with oral administration of antifungal agents accelerated healing of mucosal lesions by 3-5 days in comparison with the local use of povidone iodine. Oral administration of antifungal agents in combination with the local application of Akhizunber on mucosal lesions in combined therapy of patients with oral candidiasis showed high effectiveness and can be considered as an alternative treatment option.