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Assessment of the clinical effectiveness probability for the empiric therapy of oral fungal infections

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Mariusz Bochniak, Aida Kusiak

1/2017/XLV s. 11–20
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Fraza do cytowania: Bochniak M., Kusiak A. Assessment of the clinical effectiveness probability for the empiric therapy of oral fungal infections. Dental Forum. 2017;XLV(1):11–20. DOI:

Introduction. Infections caused by yeast‑like fungi are some of the most common oral mucosa diseases. Targeted therapy, following antifungal susceptibility tests, is the most beneficial course. But in some clinical situations where empiric therapy is administered, the appropriate antifungal agent must be chosen based on published data about expected pathogens' resistance. Aim. The aim of the study was an assessment of the clinical effectiveness probability for the empiric therapy of oral mucosa candidosis, based on the antifungal resistance profile of isolated yeast‑like strains. Material and methods. The research material consisted of 197 patients from the Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdańsk, Poland. The results of mycological cultures, used in routine clinical diagnostic and treatment algorithms for oral cavity fungal infections, were analyzed. Sensitivity tests for 7 antifungal drugs (nystatin, amphotericin B, fluconazole, miconazole, ketoconazole, itraconazole and flucytosine) were performed. Including multi‑infection cases, the clinical efficacy probabilities of empirically administered antifungal agents were evaluated in the whole group and in 3 subgroups, assigned according to age. Results and conclusions. In studied group a total of 223 strains of yeast‑like fungi were isolated. The most often isolated Candida albicans had the highest susceptibility to all the tested antifungal drugs. The Geotrichum candidum and Candida tropicalis strains also had low resistance to the tested antifungal agents. The highest antifungal resistance was observed among the Candida guilliermondii, krusei and glabrata species. Amphotericin B and nystatin were characterized by the highest probability of clinical efficacy, considering all the isolated yeast‑like fungi, while the azole derivatives were evaluated as less predictable in terms of empirical administration. The empiric therapy ineffectiveness risk increased in the subgroup of patients aged over 60.

Key words: yeast‑like fungi, Candida spp., oral candidosis, antifungal resistance, antifungal susceptibility.

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