Nystatin Effectiveness in Oral Candidiasis Treatment: A Systematic Review & Meta-Analysis of Clinical Trials

Abstract

Oral candidiasis is the most common opportunistic fungal infection caused by commensal Candida species. Since there are various local and systemic predisposing factors for the disease, the treatment also varies from topical to systemic antifungal agents. Nystatin is a common antifungal agent used topically. The aim of this systematic review was to evaluate and compare the efficacy of different antifungal agents and the safety of nystatin in the treatment of oral candidiasis. Three electronic databases were searched for randomized controlled trials comparing nystatin with other anti-fungal therapies or placebo. Clinical and/or mycological cure was the outcome evaluation. A meta-analysis and descriptive study on the efficacy, treatment protocols, and safety of nystatin was also conducted. The meta-analysis included five studies, which compared the efficacy of nystatin suspensions with photodynamic therapy. A significant difference in the colony-forming units per milliliters (CFU/mL) of Candida species was observed at 60 days intervals for both palatal mucosa and denture surfaces, with both groups favoring nystatin with low heterogeneity at a 95% confidence interval. Nystatin and photodynamic therapy were found to be equally effective for the clinical remission of denture stomatitis as well as a significant reduction of CFU/mL of Candida species from dentures and palatal surfaces of the patients.

Management of Chronic Atrophic Candidiasis (Denture Stomatitis)—A Narrative Review

“…The studies focused on a range of treatments for DS, including antifungal agents, lasers, photodynamic therapy, microwave radiation, phytomedicine using natural products, and antimicrobial agents. Of the 34 RCTs, 31 were evaluated in the 15 systematic reviews [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] included in this study. The main findings of the systematic reviews based on RCTs are summarized in Table 1 .…”

“…A review of recent publications has shown that PDT was just as effective as conventional antifungal medications, particularly nystatin, in the clinical remission of DS and considerably reducing the colony-forming units (CFU/mL) of Candida species from dentures [ 18 , 35 , 39 , 42 , 43 ]. However, the recurrence of DS following PDT has also been reported [ 18 ].…”

Antifungal Properties of Biogenic Selenium Nanoparticles Functionalized with Nystatin for the Inhibition of Candida albicans Biofilm Formation

“…Samples were aseptically withdrawn at different time intervals. SeNPs were separated from cells, purified, and stored in water at 4 °C for further analysis [ 12 ].…”

“…Furthermore, current antifungal drugs are ineffective against C. albicans biofilms, because antifungal molecules are absorbed through the extracellular polymers of the biofilm, which have upregulated efflux systems [ 4 ]. One of the promising antifungal molecules, nystatin, is used to prevent and treat C. albicans for recurrent topical or oral fungal infections [ 10 , 11 , 12 ]. However, a higher dose of nystatin can cause kidney problems, rashes, nausea, diarrhea, and vomiting.…”

“…However, a higher dose of nystatin can cause kidney problems, rashes, nausea, diarrhea, and vomiting. Nystatin also has the drawback of not working against resistant Candida strains, thus requiring alternative therapies [ 12 ]. The combination of nystatin with nanoparticles (NPs) will likely increase the bioavailability and efficacy of nystatin and also a reduction in its toxicity [ 13 , 14 ].…”