Abstract
Recurrent vulvovaginal candidiasis (RVVC) is predicted to increase to almost 158 million cases annually by 2030. Extensive self-diagnosis and easily accessible over-the-counter (OTC) fungistatic drugs contribute to antifungal-resistance, illustrating the need for novel therapies. Honey possesses multiple antimicrobial mechanisms, and there is no antimicrobial resistance towards honey reported. We evaluated the susceptibility of five clinical isolates of Candida albicans and a control strain to regular honey and a medical grade honey (MGH) gel formulation (L-Mesitran, containing 40% honey and vitamins C and E) using an adapted version of the EUCAST protocol at pH 5.2, 4.6, and 4.0. 40% regular honey did not kill or inhibit C. albicans. In contrast, the minimal inhibitory concentration (MIC) of L-Mesitran was 25%–50%, while fungicidal effects occurred at a 50% concentration (MBC) of the MGH formulation, except for one strain which was not killed at pH 4.0. Overall, pH had little effect on antimicrobial activity. MGH formulation L-Mesitran has antimicrobial activity against C. albicans over a relevant pH range. The vitamin supplements or other components of L-Mesitran may enhance the antifungal activity of the honey. This study supports performing clinical trials for conditions, such as RVVC, to find an alternative to available OTC fungistatic drugs.
Highlights
Candida albicans causes 80–92% of all vulvovaginal candidiasis (VVC) [1,2]
The minimal inhibitory concentration (MIC) of L-Mesitran was 25%–50%, while fungicidal effects occurred at a 50% concentration (MBC) of the medical grade honey (MGH) formulation, except for one strain which was not killed at pH 4.0
To ensure that the isolates were representative for the general population with common vaginal infections caused by Candida, we randomly selected five clinical Candida albicans isolates from vaginal swab specimens submitted for routine diagnostic purposes because of vaginal discharge
Summary
Candida albicans causes 80–92% of all vulvovaginal candidiasis (VVC) [1,2]. Self-diagnosis was found to have an accuracy rate of only 28% for C. albicans infection in self-treating women, and over-the-counter (OTC). Vaginal isolates of C. albicans are largely azole sensitive currently, there is an increase in azole-resistance [8,9]. Possible causes of relapse include factors such as host immune status and sensitivity to fungal antigen, in addition to errors in self-diagnosis and self-medication. In this context, the availability of effective alternatives to azole antifungal agents with different mechanisms of action could have a significant impact on the global burden of health-care costs and patient’s lives
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