Dental Student (Year 4), Faculty of Dentistry, University of Toronto, Toronto, Canada.
Assistant Professor, Department of Clinical Sciences (Pharmacology and Preventive Dentistry), Faculty of Dentistry, University of Toronto, Toronto, Canada.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Nov;130(5):533-546. doi: 10.1016/j.oooo.2020.08.011. Epub 2020 Aug 18.
Oral candidiasis is a common opportunistic infection that requires knowledge of the various clinical presentations and management strategies for successful treatment. Numerous local and systemic factors contribute to the development of candidiasis, and the infections can range from superficial mucocutaneous overgrowths to invasive bloodstream infections with a high mortality rate. In addition to Candida albicans, various fungal strains have been isolated from the oral cavity, including C. tropicalis, C. glabrata, C. krusei, and many others. Antifungal agents are available in various forms, each with differing indications, dosing regimens, adverse effects, and drug interactions. Some antifungal agents are available as oral suspensions, pastilles, or creams, whereas others are administered systemically in capsule or intravenous form. This review describes the various presentations of oral candidiasis and the diagnostic methods and treatment alternatives, with a specific focus on pharmacologic management. Spectra of activity, mechanisms of action, adverse reactions, drug interactions, and dosing regimens are explored in the context of both topical and systemic pharmacotherapy used to treat candidiasis. Polyenes (nystatin, amphotericin B); azoles (ketoconazole, miconazole, clotrimazole, fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole); and echinocandins (caspofungin, micafungin, anidulafungin) are discussed. Novel approaches in antifungal therapy with the use of probiotics are also reviewed.
口腔念珠菌病是一种常见的机会性感染，需要了解各种临床表现和管理策略，以实现成功治疗。许多局部和全身因素促成了念珠菌病的发生，感染范围从浅表黏膜过度生长到侵袭性血流感染，死亡率很高。除了白色念珠菌外，各种真菌菌株已从口腔中分离出来，包括热带念珠菌、光滑念珠菌、克柔念珠菌等。各种形式的抗真菌药物都有，每种药物都有不同的适应证、剂量方案、不良反应和药物相互作用。一些抗真菌药物可制成口腔混悬液、锭剂或乳膏，而另一些则以胶囊或静脉注射的形式全身给药。这篇综述描述了口腔念珠菌病的各种表现形式以及诊断方法和治疗选择，特别关注药物治疗管理。在局部和全身药物治疗中，探讨了抗真菌药物的作用谱、作用机制、不良反应、药物相互作用和剂量方案，用于治疗念珠菌病。多烯类（制霉菌素、两性霉素 B）；唑类（酮康唑、咪康唑、克霉唑、氟康唑、伊曲康唑、伏立康唑、泊沙康唑、艾沙康唑）；棘白菌素类（卡泊芬净、米卡芬净、阿尼芬净）。还综述了使用益生菌进行抗真菌治疗的新方法。
