J Clin Exp Dent. 2014;6(5):e576-82.

Treatment of oral candidiasis

doi:10.4317/jced.51798
http://dx.doi.org/10.4317/jced.51798

Journal section: Oral Medicine and Pathology

Publication Types: Review

Current treatment of oral candidiasis: A literature review

Carla Garcia-Cuesta 1, Maria-Gracia Sarrion-Prez 2, Jose V. Bagn 3

Dentist. Postgraduate in Oral Medicine

Associate profesor of Oral Medicine Unit. Department of Stomatology. University of Valencia
3
Chairman of Oral Medicine. Oral Medicine Unit. Department of Stomatology. University of Valencia. Head of the Department of
Stomatology and Maxilofacial Surgery. Valencia University General Hospital
1
2

Correspondence:
Avd. / Maestro Rodrigo 13-16
46015 Valencia, Spain
carlagcuesta@gmail.com

Received: 19/06/2014
Accepted: 26/07/2014

Garcia-Cuesta C, Sarrion-Prez MG, Bagn JV. Current treatment of oral

candidiasis: A literature review. J Clin Exp Dent. 2014;6(5):e576-82.
http://www.medicinaoral.com/odo/volumenes/v6i5/jcedv6i5p576.pdf
Article Number: 51798
Medicina Oral S. L. C.I.F. B 96689336 - eISSN: 1989-5488
eMail:
Indexed in:
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DOI System

Abstract
Candidiasis or oral candidosis is one of the most common human opportunistic fungal infections of the oral
cavity. This pathology has a wide variety of treatment which has been studied until these days. The present study
offers a literature review on the treatment of oral candidiasis, with the purpose of establish which treatment is the
most suitable in each case. Searching the 24 latest articles about treatment of candidiasis it concluded that the
incidence depends on the type of the candidiasis and the virulence of the infection. Although nystatin and
amphotericin b were the most drugs used locally, fluconazole oral suspension is proving to be a very effective
drug in the treatment of oral candidiasis. Fluconazole was found to be the drug of choice as a systemic treatment
of oral candidiasis. Due to its good antifungal properties, its high acceptance of the patient and its efficacy
compared with other antifungal drugs. But this drug is not always effective, so we need to evaluate and
distinguish others like itraconazole or keto- conazole, in that cases when Candida strains resist to fluconazole.
Key words: Candidiasis, treatment, miconazole, fluconazole, nystatin.

among other states that diminish the quality of defense of

the individual (2). Oral candidiasis is one of the most
common clinical fea- tures of those patients infected
with the human immuno- deficiency virus [HIV], this
manifestation was seen in up to 90% of individuals
infected with HIV (3).

Introduction
The incidence of fungal infections has been increasing
over the last decades, being more prevalent in
developed countries (1). An increase incidence of the
infections is associated with some predisposing factors
(Table 1) as the use of dentures, xerostomia, prolonged
therapy with antibiotics, local trauma, malnutrition,
endocrine disor- ders, increased longevity of people,
e1

J Clin Exp Dent. 2014;6(5):e576-82.

Table 1. Predisposing factors.

Systemic
Hormonal disorders
Physiological disorders
Endocrine disorders
Immunologic disorders
Xerostomia

Treatment of oral candidiasis

Drug therapy
Alcohol

Local
Epithelial changes
Poor oral hygiene
Loss of vertical dimension
Poor fitting dentures
Smoking

Oropharyngeal candidiasis is caused by the genus Candida; it is possible to isolate about 150 species. Many
of these remain as a commensal micro-organism in hu-

e2

mans, which could act as an opportunistic pathogens

of- ten associated with predisposing factors attributed
to the organism, thereby causing acute or chronic
infections (4). The most important of these species is
C. albicans, which is most commonly isolated from the
oral cavity and is believed to be more virulent in
humans, occurring in approximately 50% of the cases
of candidiasis.
Clinically there are a number of different types of oral
candidiasis (Table 2). Therefore the choice of therapy is
guided by the type of candidiasis.
The diagnosis of oral candidiasis is essentially clinical
and is based on the recognition of the lesions by the
pro- fessional, which can be confirmed by the
microscopic identification of Candida (5). The
techniques available for the isolation of Candida in the
oral cavity include direct examination or cytological
smear, culture of mi- croorganisms and biopsy which is
indicated for cases of hiperplasic candidiasis because
this type could present dysplasias (6).
The treatment of oral candidiasis is based on four fundaments (7): making an early and accurate diagnosis of
the infection; Correcting the predisposing factors or underlying diseases; Evaluating the type of Candida
infec-

tion; Appropriate use of antifungal drugs, evaluating the

efficacy / toxicity ratio in each case.
When choosing between some treatments it will take
into account the type of Candida, its clinical pathology
and if it is enough with a topical treatment or requires a
more complex systemic type (8), always evaluating the
ratio efficacy and toxicity (9). The different drugs are
contained in table 3.
Regular oral and dental hygiene with periodic oral examination will prevent most cases of oral candidiasis, so
it is need to make the patient aware of oral hygiene
mea- sures. Oral hygiene involves cleaning the teeth,
buccal cavity, tongue, and dentures. As well as the use
of anti- Candida rinses such as Chlorhexidine or
Hexetidine, so that they can penetrate those areas where
the brush does not. In addition, the need to remove the
dentures at night and wash it consciously, leaving it
submerged in a disin- fectant solution like
Chlorhexidine (10).
This study provides a literature review of the treatment
of oral candidiasis and its objectives are to establish general guidelines for treatment of oral candidiasis;
Assess the drug of choice for local treatment of oral
candidiasis; Assess the systemic treatment for oral
candidiasis.

Table 2. Clinical classification.

Acute
Pseudomembranous
Erythematous

Chronic
Pseudomembranous
Erythematous
Hyperplastic

Other lesions
Angular cheilitis
Denture-associated erythematous
Median rhomboid glossitis

Table 3. Antifungal agents. Vademecum.

DRUG

FORMULATION

DOSE

ADVERSE EFFECT

Anfotericin b

50mg for infusion

100-200mg/6h

Renal, cardiovascular, spinal and neurological

Nystatin

Suspension 60ml
Ointment 30g
Tablets

4-6ml / 6h
2 to 4 applications / day
2 every 8h

Well tolerated.

Gel 1%
Tablets 10mg
Gel

3 times / day
5 times / day
100mg /6h

Occasionally Skin irritation, burning sensation

Gel 2%
Tablets
Suspension 30 or 10cc
Tablets
Suspension

3 times/ day
200mg 1-2/day

Nausea, vomiting
Abdominal pain.

50 - 100mg/day
10mg/ml

Nausea, vomiting, diarrhea, abdominal pain.

Clotrimazole
Miconazole

Ketoconazole

Fluconazole

Uncommon
Nausea, vomiting, gastrointestinal effects

Uncommon
Burning, irritation, nausea, diarrhea,

Itraconazole

Capsule

100-200mg/day

Nausea, vomiting, diarrhea, abdominal pain.

Material and Methods

A Medline-PubMed search was made using the following key words: oral candidiasis OR oral candidosis AND amphotericin, oral candidiasis OR oral
candidosis AND nystatine, oral candidiasis OR
oral candidosis AND miconazole, oral candidiasis
OR oral candidosis AND ketoconazole, oral
candidiasis OR oral candidosis AND clotrimazole,
oral candidia- sis OR oral candidosis AND
fluconazole, oral can- didiasis OR oral candidosis
AND itraconazole, oral candidiasis OR oral
candidosis AND treatment, oral candidiasis OR
oral candidosis AND antifungal therapy.The key
words were validated by the MeSH [Medical Subject
Headings] dictionary, with use of the boolean operator
AND to relate them.
The following limits for inclusion of the studies were
esta- blished: articles published from 2000, publications
in En- glish and Spanish and publications of studies in
humans. All systematic reviews, clinical trials, metaanalysis and comparative studies were considered in
this review.
A total of 109 articles were identified, of which 30
were selected after reading the abstracts. Following
analysis of the 30 articles, we finally included a total of
24, since those publications that did not fit the aims of
the present study were excluded.

Results
A total of 24 articles were found about antifungal
treatment, of which 20 were clinical trials, 3 systematic
reviews and 1 a clinical case (Table 4, 4 (Cont)).

Discussion
Candida infection today is highly prevalent, especially the increase in carriers of removable dentures and
poor oral hygiene society. Depending on its virulence,
location and type of candidiasis there will carry on one
treatment or another.
First has been supported the use of conservative measures before starting drug treatment, promoting good
oral hygiene along with removing the dentures at night,
thereby it will benefit the removal of the biofilm layer
generated in the prosthetic surface (11). Dentists should
also correct the predisposing factors and underlying diseases and try to promote the use of oral antiseptic and
antibacterial rinses such as Chlorhexidine or Hexetidine
(12). These measures are very effective in patients with
denture stomatitis (12). It was also found in the study
of Cross et al. (13) that in patients with good oral
hygiene the recurrence of candidiasis after 3 years was
lower.
Regarding the pharmacological treatment of candidiasis
can be distinguished between two procedures. Topical
drugs, which are applied to the affected area and treat
superficial infections and systemic drugs those that are

prescribed when the infection is more widespread and

has not been enough with the topical therapy.

As first choice for local treatment has been for years

the nystatin at doses of 100 000 IU/ml [5ml 4 times
daily] and amphotericin b at 50mg [5ml 3 times per
day]. This choice is because they are poorly absorbed
by the in- testinal tract and therefore most of the
antifungal is ex- creted without undergoing any
change, thereby reducing hepatotoxicity (14).
However, the unpleasant taste and prolonged pattern
compromise treatment compliance by the patient (1416).
Throughout the years it has been studying the
effective- ness of other drugs like fluconazole oral
solution. Many authors have focused on evaluating
the efficacy and safety of fluconazole oral solution for
the treatment of oropharyngeal candidiasis, especially
pseudomembra- nous type, giving good results,
although many studies are still needed (14-18).
In a recent study conducted in 19 patients with
pseudo- membranous candidiasis show that
fluconazole suspen- sion in distilled water [2mg/ml]
reaches a 95% cure.
The guideline was to rinse with 5ml of the drug
solution for 1 minute and then spit it out and repeat
this action 3 times a day for 1 week. Another study
which inclu- ded 36 children with pseudomembranous
candidiasis showed that fluconazole oral suspension
10mg/ml dose gave better results than nystatin. The
main problem was the poor adherence of the nystatin
to the oral mucosa and thus the quick ingestion of the
suspension, resulting in a lower efficiency (14).

On the other hand, in another study comparing

amphote- ricin b suspension, the fluconazole oral
suspension gave better results in terms of the
eradication of Candida (16). The same was
corroborated by Taillandier et al. (18), which reported
that fluconazole oral suspension was as effective as
amphotericin b, but it was better accepted by the
patient.
Fluconazole oral suspension is administered in a dosage
of 10 mg / ml aqueous suspension by administering 5
ml daily for 7 or 14 days. Different studies show that it
is a very effective drug against pseudomembranous
candi- diasis, as it has good adhesion to the surface of
the oral mucosa and a rapid symptomatic response. It
also offers the convenience of a one-daily dosing,
which may ex- plain the better patient compliance (1418).
Another topic drug widely used is miconazole (19).
We found it in the form of gel, applying it directly on
the affected area, at doses of 200-500 mg per day, divided into 4 times. Despite its good properties it has the
drawback of possible interaction with other drugs, such
as warfarin. This is because the antifungal inhibit the
en- zyme cytochrome P-450, which affects the
clearance of certain drugs (20,21). In addition, this drug
is absorbed by the intestine, therefore care must be
taken when is administrated.
It has been introduced in the market an alternative presentation of miconazole. A one-daily miconazole 50 mg

Table 4. Summarized articles.

Author/ Year
Manfredi et
al. (11) 2006

Koray et al.
(12)
2005

Cross et al.
(13)
2004
Goins et al.
(14)
2002

Article

Type of article
/ Sample
In vitro antifungal susceptibility to
Clinical trial
six antifungal agents of 229
Candida isolates from patients
n=821
with diabetes mellitus
Fluconazole and/or hexetidine for
management of oral candidiasis
associated with denture-induced
stomatitis

Clinical trial

Evaluation of the recurrence of

denture stomatitis and Candida
colonization in a small group of
patients who received itraconazole
Comparison of fluconazole and nystatin oral suspension for treatment
of oral candidiasis in infants

Clinical trial

n=61

n=22
Clinical trial
n=19
n=15

Epstein et al.
(15)
2002
Lefebvre et
al. (16)
2002

Sholapurkar
et al. (17)
2009

Taillander et
al. (18)
2000

Isham et al.
(19) 2010
Pemberton et
al. (20)
2004
Miki et al.
(21)
2011

Drug

Dose

Conclusions

Itraconazole
Miconazole
Ketoconazole
Fluconazole
Anfotericin b
Hexetidine
rinse
Heksoral
0,1%
Fluconazole
Zolax capsules
Itraconazole
rinse
Itraconazole
capsules
Nystatin suspension
Fluconazole
suspension
(Diflucan)
Fluconazole
oral solution

In vitro
preparations

Those strains that were

resistant to fluconazole
also were resistant to
other drugs.

2/d

Supports the use of

antiseptics or
hexetidine as a
first choice.
Conservative i
ntervention

Fluconazole
oral solution
5ml

Fluconazole mouthrinses for oral

candidiasis in postirradiation
transplant, and other patients
A comparative study of the
efficacy and safety of fluconazole
oral suspension and
amphotericin B oral suspension in
cancer patients with mucositis

Clinical trial

Comparison of efficacy of
fluconazol mouthrinse and
clotrimazole mouthpaint in the
treatment of oral candidiasis

Clinical trial
n= 27
n= 28

Clotrimazole

A comparison of fluconazole oral

suspension and amprotericin B oral
suspension in older patients with
oropharyngeal candidosis

Clinical trial
n=150

Fluconazole
oral suspension

n= 155

Antifungal activity of miconazole

against recent Candida strains
Miconazole oral gel and drug
interactions

Clinical trial
n=25
Clinical case

Anfotericin b
oral suspension
Miconazole

Warfarin and miconazole oral gel

interactions: analysis and therapy
recommendations based on clinical
data and a pharmacokinetic model
Collins et al.
Management of oropharyngeal
candidiasis with localized oral
(22)
miconazole therapy: efficacy,
2011
safety, and patient acceptability
Vazquez et al. Miconazole Mucoadhesive Tablets:
(23)
A Novel Delivery System
2012

n=19
Clinical trial
n=123
n=120l

Systematic
review

Anfotericin b
oral solution
5ml
Fluconazole

50 mg 1/d

10ml 2/d
100mg 2/d15d

Best systemic
itraconazole

1ml
4/d-10d

Fluconazole more
effective

10mg/ml
1/d-7d
5ml 3/d

Clinical improvements

5 ml (50 mg)
1/d

Better accepted the

fluconazole

5ml- 3/d
7-14 d

5ml
3/d -14d

Mayor cure rate with

fluconazole

mouthpaint
3/d
5ml(50mg)
1/d

No significant
difference

5ml- 3/d

Miconazole presents
great inhibitory activity
Miconazole gel
Decreased the
clearance of some
drugs and is absorbed
by the intestine
Miconazole gel 200-400 mg/d Interactions with other
drugs
In vitro preparation
125mg/d 3d

Systematic
review

Miconazole
buccal tablets

50mg 1/d

Limited systemic
absorption. Good
efficacy

Systematic
review
n=25

Miconazole
mucoadhesive
tablets

50mg 1/d

Little systemic
absorption.
94.7% efficacy

Table 4 (Cont). Summarized articles.

Author/ Year

Article

Czerninski et
A novel sustained-release
al. (24)
clotrimazole varnish for local treatment of
2010
oral candidiasis
Oji et al. (25)
Evaluation and treatment of oral
2008
candidiasis in HIV/AIDS patient in
Enugu, Nigeria

Type of article
/ Sample
Clinical trial
n= 14
Clinical trial
n=29

Bensadoun et Comparison of the efficacy and safety of

al. (26)
miconazole 50-mg mucoadhesive buccal
2008
tablets with miconazole 500-mg gel in the
treatment of oropharyngeal
candidiasis
Koks et al.
Prognostic factors for the clinical
effectiveness of fluconazole in the
(27)
treatment of oral candidiasis in HIV-12002
infected individuals
Lyon et al.
Correlation between adhesion,
enzyme production, and
(28)
susceptibility to fluconazole in Candida
2006
albicans obtained from dentures wearers
Oude Lashof
An open multicentre
et al. (29)
comparative study of the efficacy, safety
and tolerance of fluconazole and
2004
itraconazole in the treatment of cancer
patients with oropharyngeal candidiasis

Clinical trial

Kuriyama et
al. (30)
2005

Clinical trial

In vitro susceptibility of oral

Candida to seven antifungal agents

n=141
Clinical trial

Clotrimazole
varnish and
troches
Nystatin rinses
(micostatin)
Ketoconazole
tablets
(nizoral)
Miconazole
mucoadhesive
tablets
Miconazole gel

5 times/d

Varnish more
prolonged effect

5ml
4/d- 14d
200mg/ d
14d

For HIV patients,

more effective the
systemic treatment
(ketoconazole)

50mg 1/d

Best treatment plan

the mucoadhesive
tablets

125mg 4/d
Great efficacy of
fluconazole

n=28
Clinical trial

Fluconazole

In vitro
preparations

Fluconazole
capsules

100mg 1/d10d

Fluconazole
reduces erythema
and cell
colonization
Fluconazole better
result

n=99
Clinical trial
n=252

n=521

Clinical trial
n=71 cepas de
Cndida

Ally et al.
(32)
2001

A randomized, double-blind,
double-dummy, multicenter trial of
voriconazole and fluconazole in the
treatment of esophageal candidiasis in
immunocompromised patients
Comparative evaluation of
ketoconazole tablet and topical
ketoconazole 2% in orabase in treatment
of Candida-infected denture stomatitis.

Comparative
clinical trial

Comparative efficacy of topical therapy

with a slow-release mucoadhesive buccal
tablet containing miconazole nitrate
versus systemic therapy with
ketoconazole in HIV-positive patients
with oropharyngeal candidiasis

Conclusions

100mg/d

In vitro antifungal susceptibility of

Candida spp. Oral isolates from HIVpositive patients and control individuals

Van Roey et
al. (34)
2004

Dose

Fluconazole
capsules
Diflucan

Brito et al.
(31)
2011

Khozeimeh et
al. (33)
2010

Drug

n=256
Clinical trial
n=30

Clinical trial
n=167
n=165

Itraconazole
capsules
Fluconazole
Itraconazole
Voriconazole
Ketoconazole
Miconazole
Anfotericin b
Nystatin
Anfotericin b
Fluconazole
Flucytosine
Nystatin
Ketoconazole
Fluconazole
capsules
Voriconazole
capsules
Ketoconazole
systemic
Ketoconazole
topical
Miconazole
mucoadhesive
tablet
Miconazole
mucoadhesive
tablet
Ketoconazole
tablets

200mg 1/d15d
In vitro
Some Candida
preparations species are resistant
to antifungal drugs

In vitro preparations

Antifungal agents
showed good
activity against the
strains

200mg 1/d

Voriconazole was at
least as effective as
fluconazole

200mg 1/d
200mg 1/d
2% 2/d
50 mg
10mg

400 mg
1/d- 14d

Miconazole
mucoadhesive
tablet used as
first-line treatment
because of its good
tolerance
Miconazole
mucoadhesive
tablets were as
effective as other
systemic drugs

mucoadhesive buccal tablet. It has a limited systemic

absorption. Its performance is mostly local and it has a
convenient application form. Patients are instructed to
apply the rounded side of the 50 mg tablet to the upper
gum region just above the right or left incisor following
brushing of teeth in the morning. The tablet should be
held in place until dissolved (22,23). It has the advantage of being applied once daily instead 5 times a day
with clotrimazole (24), and 4 times daily with nystatin
(25). It has been demonstrated the effectiveness of this
new form of administration in the study of Bensadoun
et al. (26). 141 patients with head and neck cancer with
cli- nical signs and symptoms of oropharyngeal
candidiasis received 50 mg mucoadhesive tablets of
miconazole daily or 125 mg miconazole gel four times
per day. Cli- nical improvement was not significant
between the two groups, but the mucoadhesive tablets
exhibited higher salivary concentrations and better
tolerance for the pa- tient. Despite being more
expensive, offers an effective, safe, and well tolerated
topical treatment for oropharyn- geal candidiasis
(22,23,26).
- Systemic treatment:
In spite of knowing the efficacy of the drugs listed above, when it comes to a more generalized candidiasis or
immunocompromised patients, these would not be
suffi- cient. For those cases would have to resort to
treatment with systemic drugs (25).
Since its introduction, fluconazole has been used to
treat systemic Candida infections because of its
efficacy and good tolerability. The appropriate dose is
between 50- 100 mg daily (27). Furthermore, when
dealing with im- munocompromised patients, such as
those HIV-infected, or cancerous, this drug has good
effects doubling the dose (28,29). Its efficacy has been
demonstrated (27). The dose was individualized
depending on the severity and type of candidiasis.
Patients with pseudomembra- nous type started with
100 mg fluconazole daily; patients with erythematous
variety started with 50 mg fluconazo- le. Therefore,
according to the clinic and the virulence of the
infection the dose would be titrated, giving good
results, and increasing the guideline in those cases where the fungal infection did not decrease (27).
To support the efficacy of this drug it has been
compared with other systemic antifungal agents (29). In
one ran- domized study, the efficacy of fluconazole
[100mg per day for 10 days] and itraconazole [200mg
per day for 15 days] was compared in patients with
oropharyngeal candidiasis. The results were a clinical
and mycologi- cal improvement of 66% for the first
group and 54% for those treated with itraconazole. The
main conclusion of this study is that in patients with
oropharyngeal candi- diasis, fluconazole has a
significantly better clinical and mycological cure rate
compared with itraconazole. The failures of

itraconazole may be explained by drug in- teractions and

the unpredictable absorption of itracona-

zole capsules. But when fluconazole failed,

itraconazole was prescribed to these patients, having
good results. So it is said that it was a good drug for
fluconazole-resistant Candida strains (29).
As it has been suggested above, it may happen that the
Candida strains were not susceptible to fluconazole,
and it has not any effect. In that case it will be used
other drugs like itraconazole or newest ones as
voriconazole (30). Keeping always in mind that
strains which were resistant to fluconazole were also
resistant to other drugs (31).
The new triazol antifungal voriconazole [200 mg per
day] has been shown to be a potent drug. Ally et al.
(32) compared the efficacy of voriconazole and
fluconazole in the treatment of esophageal
candidiasis. The success rate was 98.3% for
voriconazole and 95.1% for fluco- nazole. The results
show clearly that voriconazole is at least as effective
as fluconazole in the treatment of can- didiasis. It
suggests that this new agent may be a use- ful
alternative for fluconazole-resistant Candida strains
(32). Because of being a new there are little strains
resis- tant to voriconazole. The voriconazole has an
important role in the treatment of candidiasis (30),
although it is still not fully established in the market,
so many more studies and research would be needed.
There have been several studies comparing topical
and systemic drugs. In a study to treat denture
stomatitis have been compared the use of
ketoconazole tablets [200mg daily] with topical

ketoconazole [2% twice daily] and miconazole

mucoadhesive tablets (33). Due to the ad- verse effects
of ketoconazole (31) like nausea, vomiting and
gastrointestinal problems it has been supported the use
of other drugs when treating prosthetic candidiasis (34).
Thus the use of miconazole mucoadhesive tablet was
established as the drug of first line of defense for this
type of candidiasis.
General treatment guidelines include after the completion of an early diagnosis, the correction of
predisposing factors or underlying diseases and
maintaining a good oral hygiene. Moreover using
antiseptic agents such as Chlorhexidine or Hexetidine,
as well as removing den- tures at night. All of that in
order to obtain well results in the treatment of oral
candidiasis as first line of defense, continuing the
application of antifungal drugs. Begin- ning with local
treatment and keeping up the systemic ones for those
patients who do not respond to topical treatment or in
immunocompromised patients.
It has recently been found that fluconazole oral suspension as a local treatment, at a dose of 2 mg/ml 3 times
daily or 10 mg /ml once daily, gives good clinical
results, besides the better patient compliance due to the
dosage and its pleasant taste. Despite not being
currently the most widely used locally because it
requires further cli- nical studies. Nowadays the most
used drugs remains in nystatin solution which contain
100 000 IU / ml [5ml 4 times daily] and miconazole gel
[200 to 500 mg per day

divided into 4 doses]. Moreover miconazole mucoadhesive tablets [50 mg once daily] which are considered
effective in the treatment of oropharyngeal candidiasis,
but their high cost is one of the main problems.
Fluconazole at doses between 50-100 mg per day is the
systemic drug of choice because it has high efficacy
and tolerability by the patient. However it is important
to think about the voriconazole which is as effective as
flu- conazole but is still under study. Also it is need to
know about other drugs such as itraconazole, which are
effec- tive when Candida strains are resistant to
fluconazole.

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Conflict of Interest
The authors declare that they have no conflict of interest.