Primary prevention

Improved oral hygiene, especially among denture wearers, as well as salivary reconstitution in those experiencing hyposalivation/xerostomia, are among various preventive approaches.[15] Prophylaxis with antifungal agents is used to prevent local infection and systemic candidal involvement in patients undergoing radiation or chemotherapeutic cancer treatment, in immunocompromised states associated with HIV infection, or following bone marrow and organ transplants. It is recognised that there is a strong beneficial effect of antifungal prophylaxis in cancer patients, and there is strong evidence that drugs absorbed from the gastrointestinal tract prevent oral candidiasis in patients receiving treatment for cancer.[44][45][46] [ Cochrane Clinical Answers logo ] The treatment or prevention of oral candidiasis in patients being treated for cancer includes drugs fully absorbed from the GI tract (e.g., fluconazole, itraconazole).[44][45][46]

Among patients with AIDS, nystatin has been reported to delay the onset of oral candidiasis, and fluconazole has been shown to be more effective than clotrimazole at preventing development of oral candidiasis.[47][48][49][50] [ Cochrane Clinical Answers logo ] However, primary antifungal prophylaxis can lead to the development of drug-resistantCandida strains and also significant drug-drug interactions. Moreover, oropharyngeal candidiasis is associated with low morbidity and mortality, and acute antifungal therapy is highly effective. Routine primary prophylaxis is therefore not recommended.[17]​ Administration of antiretroviral therapy and immune restoration is deemed most effective in preventing oropharyngeal candidiasis.[17]​ There are insufficient data to make recommendations concerning continuous versus intermittent therapy for immunocompromised patients, as well as for the use of prophylactic antifungals in patients with diabetes.[15][51]

For neonates, the risk of oral candidiasis may be reduced by avoiding the prolonged use of antibiotics and strict hand hygiene practices. There is some evidence that among very preterm and very low birth weight infants, prophylaxis with oral/topical non-absorbed antifungal agents reduces the risk for invasive fungal infection.[52]

Secondary prevention

Oral candidiasis may be prevented by appropriate treatment for any underlying condition (e.g., management of HIV infection, malignancies, or endocrine disorders such as diabetes). Most HIV specialists do not recommend secondary prophylaxis of recurrent oropharyngeal candidiasis because of the effectiveness of acute therapy.[17]​ However, for frequent or severe recurrences, prophylaxis with oral fluconazole is recommended.[17]​​[54]

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