Abstract
ObjectiveThe aim of this study was to evaluate the effect of nystatin on the efficacy of chlorhexidine against Streptococcus mutans in planktonic cells and mixed biofilm with Candida albicans.Material and methodsS. mutans ATCC 25,175 in suspension and also combined with C. albicans ATCC 18,804 in biofilm were cultured. Minimum inhibitory concentration (MIC), crystal violet colorimetric assay, and colony-forming unit counting (CFUs/mL) were performed.ResultsAn increased MIC of chlorhexidine against S. mutans was observed when the drugs were administered mixed in a single formulation and with time intervals in between, except for the 30-min interval. The biofilm optical density (OD) in treatments using chlorhexidine and nystatin combined did not significantly differ from chlorhexidine alone. Either in biofilm colorimetric assay or determination of CFUs, the combined treatments with nystatin administered before chlorhexidine had less effect on chlorhexidine efficacy.ConclusionsNystatin interferes with the action of chlorhexidine against S. mutans. The antimicrobial effectiveness of the combined drugs depends on their concentration, time interval used, and the planktonic or biofilm behavior of the microorganisms.Clinical relevanceIn view of the great number of patients that can receive a prescription of chlorhexidine and nystatin concomitantly, this study contributes to the knowledge about the effect of the combined drugs. Given the high prevalence of prescriptions of chlorhexidine and nystatin in dentistry, dental professionals should be aware of their possible antagonistic effect.
Highlights
With increase in life expectancy, a substantial number of people experience immunodeficiency worldwide
Chlorhexidine alone and in the combinations with a 30-min interval was capable of reducing bacterial growth by 70% at the lowest concentration tested (MIC ≤ 0.50 μg/mL)
Our results showed that nystatin affected the Minimum inhibitory concentration (MIC) value of chlorhexidine against S. mutans, where all groups, except the 30-min interval ones, showed an increased MIC
Summary
With increase in life expectancy, a substantial number of people experience immunodeficiency worldwide This happens mostly as a consequence of therapies for cancer, Chlorhexidine is a cationic bisbiguanide, which is considered one of the most commonly prescribed antimicrobials due to its broad spectrum against gram-negative and gram-positive bacteria and some mycetes [3, 4]. Clinical Oral Investigations been prescribed in oral care for various purposes, such as chemical control of dental biofilm, root canal irrigation, and treatment of oral infections These include infections affecting xerostomic patients, who are at high risk of periodontal disease and dental caries, where the latter mainly involves Streptococcus mutans [3, 4, 6, 7]. Chlorhexidine has been prescribed to reduce the risk of developing ventilator-associated pneumonia in critical care patients [9]
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