Antifungal drug resistance of oral fungi

Odontology. 2010 Feb;98(1):15-25. doi: 10.1007/s10266-009-0118-3. Epub 2010 Feb 16.

Abstract

Fungi comprise a minor component of the oral microbiota but give rise to oral disease in a significant proportion of the population. The most common form of oral fungal disease is oral candidiasis, which has a number of presentations. The mainstay for the treatment of oral candidiasis is the use of polyenes, such as nystatin and amphotericin B, and azoles including miconazole, fluconazole, and itraconazole. Resistance of fungi to polyenes is rare, but some Candida species, such as Candida glabrata and C. krusei, are innately less susceptible to azoles, and C. albicans can acquire azole resistance. The main mechanism of high-level fungal azole resistance, measured in vitro, is energy-dependent drug efflux. Most fungi in the oral cavity, however, are present in multispecies biofilms that typically demonstrate an antifungal resistance phenotype. This resistance is the result of multiple factors including the expression of efflux pumps in the fungal cell membrane, biofilm matrix permeability, and a stress response in the fungal cell. Removal of dental biofilms, or treatments to prevent biofilm development in combination with antifungal drugs, may enable better treatment and prevention of oral fungal disease.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antifungal Agents / therapeutic use*
  • Biofilms / drug effects
  • Drug Resistance, Fungal*
  • Humans
  • Mouth Diseases / drug therapy*
  • Mouth Diseases / microbiology
  • Mycoses / drug therapy*
  • Mycoses / microbiology

Substances

  • Antifungal Agents