A pseudo-randomised clinical trial of in situ gels of fluconazole for the treatment of oropharngeal candidiasis

<p>Abstract</p> <p>Background</p> <p>Oropharyngeal candidasis is a common opportunistic infection seen in immunocompromised patients. Fluconazole has a broad spectrum antifungal activity including a wide variety of <it>candida </it>species. Aim of the present investigation was to formulate and find out the relative efficacy of <it>in situ </it>gels of fluconazole.</p> <p>Method</p> <p>The <it>in situ </it>gels were prepared using polymers which exhibited sol-to-gel phase transition due to change in specific physico-chemical parameters, such as ion triggered system using gellan gum (0.5% w/v) along with sodium carboxylmethylcellulose (0.35%w/v). The study design was bicenter, 'pseudo-randomised, single blind trial conducted in Mangalore., India, which includes 15 HIV positive patients, 15 patients with partial or completes dentures, and 15 patients who were treated with (active control) fluconazole tablets 100 mg/day for 14 days. Severity of disease was scored clinically before treatment and at clinical evaluations on day 3, 7, 14, 18, 21, 35, and 42. Semiquantitative microbiological cultures of oral swabs were also obtained on same days.</p> <p>Results</p> <p>All patients had mycological documented oropharyngeal candidiasis and were treated with fluconazole (0.5%w/v) <it>in situ </it>gels for 14 days Severity of disease was scored clinically before treatment and at different predetermined time intervals along with semi quantitative culture of oral swabs. The clinical response rate showed 97% cure after 14 days in the treated with <it>in situ </it>gel. In comparison, the control group treated with fluconazole tablets showed 85% improvement in symptoms of oral candidiasis. The patients suffering from HIV infection showed relapse in oral candidiasis at the end of 21 days. The patients having oral candidiasis due to partial or complete dentures showed complete recovery and were free from signs and symptoms of oral candidiasis.</p> <p>Conclusions</p> <p>The <it>in situ </it>gel formulation of fluconazole was well tolerated with no severe adverse reaction and offers a better alternative to tablet formulation in the treatment of oropharyngeal candidasis.</p> <p>Trial registration</p> <p>Current Controlled Trails <a href="http://www.controlled-trials.com/ISRCTN90634047">ISRCTN90634047</a></p

Distinctive features of the microbiota associated with different forms of apical periodontitis

Microorganisms infecting the dental root canal system play an unequivocal role as causative agents of apical periodontitis. Although fungi, archaea, and viruses have been found in association with some forms of apical periodontitis, bacteria are the main microbial etiologic agents of this disease. Bacteria colonizing the root canal are usually organized in communities similar to biofilm structures. Culture and molecular biology technologies have demonstrated that the endodontic bacterial communities vary in species richness and abundance depending on the different types of infection and different forms of apical periodontitis. This review paper highlights the distinctive features of the endodontic microbiota associated with diverse clinical conditions

In vitro antimicrobial activity of auxiliary chemical substances and natural extracts on Candida albicans and Enterococcus faecalis in root canals

OBJECTIVE: The aim of this study was to evaluate the antimicrobial activity of auxiliary chemical substances and natural extracts on Candida albicans and Enterococcus faecalis inoculated in root canals. MATERIAL AND METHODS: Seventy-two human tooth roots were contaminated with C. albicans and E. faecalis for 21 days. The groups were divided according to the auxiliary chemical substance into: G1) 2.5% sodium hypochlorite (NaOCl), G2) 2% chlorhexidine gel (CHX), G3) castor oil, G4) glycolic Aloe vera extract, G5) glycolic ginger extract, and G6) sterile saline (control). The samples of the root canal were collected at different intervals: confirmation collection, at 21 days after contamination; 1(st) collection, after instrumentation; and 2(nd) collection, seven days after instrumentation. Microbiological samples were grown in culture medium and incubated at 37º C for 48 hours. RESULTS: The results were submitted to the Kruskal-Wallis and Dunn (5%) statistical tests. NaOCl and CHX completely eliminated the microorganisms of the root canals. Castor oil and ginger significantly reduced the number of CFU of the tested bacteria. Reduction of CFU/mL at the 1(st) and 2(nd) collections for groups G1, G2, G3 and G4 was greater in comparison to groups G5 and G6. CONCLUSION: It was concluded that 2.5% sodium hypochlorite and 2% chlorhexidine gel were more effective in eliminating C. albicans and E. faecalis, followed by the castor oil and glycolic ginger extract. The Aloe vera extract showed no antimicrobial activity

Biological Tissue Response to a New Formulation of a Silicone Based Endodontic Sealer

Satisfactory biological behavior is a necessary requirement for clinical application of endodontic materials. In this study, the connective tissue responses to silicone (GuttaFlow 2), epoxy resin (AH Plus) and zinc oxide and eugenol (Endofill) based sealers were compared. Twelve Wistar rats had polyethylene tubes (four per animal) containing one of the tested sealers and empty tubes (negative control) implanted in their subcutaneous tissue. The tubes were randomly placed 2 cm from the spine and at least 2 cm apart from one another. Tissue samples with implants were processed for histological analysis after 7 or 60 days (n=6 animals per period). Inflammatory cells, fibrous condensation and abscess were scored according to their intensity. Friedman, followed by Dunn’s post hoc, was used to compare sealers. Differences between the two experimental periods were verified using Mann-Witney U test (p<0.05). At 7 days, most of the histological parameters showed no significant differences amongst groups. Endofill group scored higher than the others for giant cells (o<0.05) and promoted a greater number of samples presenting abscess formation. GuttaFlow 2 tended to show a less intense inflammatory infiltrate compared to the other materials. At 60 days, there were no significant differences between groups in most of the histological parameters evaluated. However, it was observed that Endofill scored higher for macrophages (p<0.05) compared to the control group, and GuttaFlow 2 tended to present lower scores than the others for neutrophils and abscess. GuttaFlow 2 showed proper biological behavior and should be considered adequate for clinical practice