Nystatin 100,000units/g / Chlorhexidine hydrochloride 1% / Hydrocortisone 0.5% cream

Conventional treatments for oral candidiasis often fail due to the complexities of the oral environment and the increasing antifungal drug resistance. Therefore, there is a growing demand for new therapies that optimize drug bioavailability, allowing for lower therapeutic doses while enhancing cytocompatibility, maintaining antifungal, anti-inflammatory, and wound healing efficacy. This study investigated the antifungal activity, cytocompatibility, wound healing potential, and mucosal adhesion of novel mucoadhesive formulations containing nystatin (NYS) or chlorhexidine (CHX) complexed with β-cyclodextrin (βCD), compared with the drug-free formulation (GEL) and the standard treatment with 2% miconazole gel (DK-Daktarin). Efficacy against Candida albicans was evaluated by measuring the metabolic activity, whereas cytocompatibility with human gingival fibroblasts (HGFs) was analyzed for viability, morphology, lactate dehydrogenase (LDH) release, and apoptosis. Additionally, wound healing potential was investigated by assessing cell migration efficacy, anti-inflammatory activity, and reactive oxygen species (ROS) scavenging activity. Mucoadhesion was evaluated using mucin discs and a texture analyzer. Mucoadhesive gels containing βCD-complexed NYS or CHX exhibited significantly higher antifungal activity when compared to the GEL and DK groups (p < 0.05). Compared to fibroblast control cultures, those exposed to drug-complexed gels exhibited similar viability (p > 0.05) and morphological parameters, lower LDH release (p < 0.05), and similar apoptosis rates (p > 0.05). Additionally, exposure to the βCD-modified gels was associated with complete wound closure (p > 0.05), significant anti-inflammatory effect, with downregulation of pro-inflammatory gene expression (p < 0.05), and higher ROS scavenging activity (p < 0.05). The developed formulations showed no difference in mucoadhesiveness (p > 0.05), which was superior to that of DK (p < 0.05). Therefore, the proposed drug-complexed mucoadhesives are promising therapeutic options for oral candidiasis.

Abstract licence: CC BY

ABSTRACT Objective: To evaluate the antifungal effect of 25% Tea tree oil and compare it to 2% Chlorhexidine and Nystatin against Candida albicans at both the 4th day and 7th day of inoculation to explore potential alternative treatment options for fungal infections in endodontic therapy. Material and Methods: 82 single-canal human mandibular premolar teeth were cleaned, prepared, and inoculated with a C. albicans suspension. After incubating for 4 and 7 days, the teeth were randomly assigned to receive one of four treatments: Nystatin, Chlorhexidine (CHX), Tea tree oil (TTO), or Dimethyl Sulfoxide (DMSO). After treatment, samples were rinsed and dried. Dentine shavings were collected and incubated to observe the growth of C. albicans. The antifungal activity was measured by the number of Candida colony-forming units. Two-way ANOVA followed by post-hoc Tukey's test was applied to compare the CFU growth. Results: TTO exhibited comparable antifungal activity to CHX (p=0.976) and superior antifungal activity compared to Nystatin (p&lt;0.001). Conclusion: 25% Tea tree oil shows antifungal efficacy against C. albicans, comparable to 2% Chlorhexidine, suggesting it could be a viable alternative for endodontic treatments. However, Nystatin demonstrated only limited antifungal effectiveness.

Abstract licence: CC BY

Nystatin is a polyene macrolide antibiotic with broad-spectrum antifungal activity and serves as a key therapeutic agent for superficial fungal infections. This review systematically elaborates on its multicomponent chemical nature, its mechanism of action targeting ergosterol, and highlights the potential adverse effects, such as cardiotoxicity, associated with impurities like RT6 (albonoursin). The fundamental analytical techniques for quality control are outlined. Furthermore, the clinical applications and combination therapy strategies of nystatin in treating oral diseases, vaginitis, and otitis externa are summarized in detail. Regarding biosynthesis, the assembly mechanism of nystatin A1 via the type I polyketide synthase pathway and its subsequent modification processes are thoroughly discussed. Emphasis is placed on the latest advances and potential of gene-editing technologies, particularly CRISPR/Cas9, in the targeted knockout of genes responsible for toxic components and in optimizing production strains to enhance nystatin yield and purity. Finally, this review prospects the future development of nystatin towards improved safety and efficacy through structural optimization, innovative delivery systems, and synthetic biology strategies, aiming to provide a reference for its further research and clinical application.

Abstract licence: CC BY