Nystatin Suspension Research Articles

Micro-electrode array recording of extracellular electrical potentials of liquid static surface fermented Hericium erinaceus

Hericium erinaceus is a basidiomycetes fungus with previously uncharacterised extracellular electrophysiology. Here, we present results of recordings of the electrical potentials of fungal biofilms of this species using microelectrode arrays (MEAs). In particular, we focused on modelling the temporal and spatial progression of the low frequency (≤ 1 Hz) potentials. Culture media control studies showed that the electrical potential activity results from the growth and subsequent spiking behaviours of the mycelium extracellular matrices. An antifungal assay using nystatin suspension, 10,000 unit/mL in DPBS, provided evidence for the biological origin of electrical potentials due to targeting of the selective permeability of the cell membrane and subsequent cessation of electrical activity. Conversely, injection of L-glutamic acid increased the combined multi-channel mean firing rate from 0.04 Hz to 0.1 Hz. Analysis of bursting and spatial propagation of the extracellular signals are also presented.

Role of Some Natural products as a Disinfectant on Color of GC-SoftLiner

The study aims to evaluate the effect of some natural products (nigella sativa. sesame, flax amd ginger oil) (Emad factory/mosul/Iraq) in relation to nystutin suspension on color of GC-Soft Liner Fifly Sample were prepared frum-GC-extra soft lining material, they were (10*10%2mm). Half of the samples for each group were immersed for 8hr in these oils after they had been infected with Candida albicans and incubated [ur 48hr, the other half of the samples immersed for Bhr daily fur one month. This study compared antifungal efficiency before and after immersion in distilled water (Negative Control), nystatin suspension (100000 LU/ml as a positive control), nigella sativa, sesame, flax and ginger oil. Color of samples tested by Vita — Easy Shade system, the statistical tests used were analysis of variance, Durinet T-test. The resulls demonstrated that there were significant differences between all tested oils znd DW in refution to antifungal action, and no significant differences between all tested oils and D.W iu relation 0 color of GC-solt Lining maternal al (P=0.05). All the tested natural oils were effective antifungal agents and would be accepted and safe in relation to the color of soft hnet.

A Case of Oral Candidiasis Treated with Fluconazole (Diflucan®) Mouthrinse

Oral candidiasis, a common fungal infection in humans, is characterized by the overgrowth of Candida species in the superficial oral epithelial mucosa. The condition is associated with multiple risk factors, including impaired salivary gland function, oral mucosal damage, and long-term antibiotic or corticosteroid use. Several treatment options are available; nystatin and amphotericin B are the most widely used local medications. Recently, fluconazole has emerged as the preferred systemic treatment. We report a case of oral candidiasis in an 83-year-old male diagnosed with bullous pemphigoid in 2017 and previously administered methylprednisolone. He developed oral candidiasis a few months before presentation and was treated with 10 mL nystatin suspension three times daily; unfortunately, the disease was recalcitrant to this treatment and his symptoms showed no improvement over two months. We discontinued nystatin in favor of fluconazole syrup (Diflucan®) administered by rinsing, then swallowing, 5 mL syrup once daily. The lesion improved after one month of treatment. This case demonstrates the efficacy of fluconazole as a primary treatment for oral candidiasis. The act of rinsing the mouth with syrup exposes the oral mucosa to drug, potentially producing a better treatment response than taking the syrup orally without rinsing.

In Vitro Effect of a High-Intensity Laser on Candida albicans Colony Count.

Introduction: This study assessed the effect of a high-intensity laser on Candida albicans colony count. Methods: This in vitro, experimental study was conducted on standard-strain C. albicans (ATCC18804). Seventy-two samples with two different concentrations of C. albicans (104 cells/mL and 106 cells/mL) were randomly assigned to three groups of control, laser and nystatin. Each group included 12 samples from each concentration. In the nystatin group, 10 cc of nystatin suspension was added to the samples and mixed for 30-60 seconds. In the laser group, the Ga-Al-Ar diode laser with a 940-nm wavelength and 2-W power was irradiated to the samples with 0.4 mm tip diameter in non-contact mode (1-mm distance) at a speed of 1 mm/s. The suspensions in the three groups were cultured on the Sabouraud dextrose agar culture medium and incubated at 37°C for 24 hours. The number of C. albicans colonies was then counted and reported. The three groups were compared by ANOVA and Tukey's test (alpha=0.05). Results: In both concentrations, the mean colony count in the nystatin group was significantly lower than that in the control (P<0.05) and laser (P<0.05) groups. The mean colony count in the laser group was significantly lower than that in the control group (P<0.05). Conclusion: The high-intensity laser with a 940-nm wavelength and 2-W power in non-contact mode can significantly decrease the C. albicans colony count in vitro, but its effect is lower than that of nystatin.

Resilient liner modified by antimicrobials for denture stomatitis treatment: A randomized controlled trial

ObjectivesThis randomized clinical trial evaluated the effectiveness of an interim denture resilient liner (Trusoft) modified with minimum inhibitory concentrations (MICs) of antimicrobial agents for Candida albicans biofilm in the denture stomatitis (DS) treatment. MethodsForty participants with DS and maxillary complete denture (MCD) wearers were randomly assigned to one of the treatments for 14 days (n=10): nystatin oral suspension (Control-100,000IU/mL; 4 × /day), MCD relined with Trusoft either without (Tru) or with nystatin (Ny) or chlorhexidine diacetate (Chx) at MICs. Cytological smears and mycological quantitative cultures were taken from the palate and denture before treatment (baseline), at the end of treatment (day 14), and at follow-up (days 30, 45, and 60). Photographs of the palate were made at each visit. Data were analyzed by the Cochran and χ2 tests, ANOVA and the Tukey test or the Friedman and Kruskal-Wallis tests (α=0.05). ResultsPalatal smears of the Ny and Chx groups exhibited no mycelial Candida (0%) on day 14, and, at the 60-day follow-up, it was observed for only 1 participant from Chx group. MCD smears showed reduction in mycelial forms for all groups on day 14 (P<0.05), but this difference was maintained at follow-up only for the relined dentures (P<0.05). Unlike Tru and the control groups, Ny and Chx groups evidenced a significant reduction in CFU/mL values and DS severity throughout the trial (P<0.05). ConclusionsThe addition of nystatin and chlorhexidine at MICs to an interim resilient liner is a promising treatment for DS, with better results than those for conventional therapy with nystatin suspension, including the follow-ups. Clinical significanceCompared with conventional topical antifungal therapy, modifying a denture reline material with antimicrobials provided a therapeutic option for denture stomatitis. This non-invasive, straightforward therapeutic approach can be easily adopted by dentists and has the advantage of not requiring patient compliance while maintaining therapeutic concentrations on the denture base.

The biocompatibility and antifungal effect of Rosmarinus officinalis against Candida albicans in Galleria mellonella model

This study was performed to evaluate the biocompatibility and antifungal effect of Rosmarinus officinalis against Candida albicans in Galleria mellonella model. Five different concentrations of R. officinalis glycolic extract (50; 25; 12.5 e 6.25 mg/mL) were used to evaluate its biocompatibility in G. mellonella model, in which the nystatin suspension (100; 50; 25; 12.5 e 6.25%) was used as a control group. The antifungal action of R. officinalis glycolic extract was evaluated on C. albicans for 72, 48 and 12 h at two different phases: (1) using the extract as therapeutic agent; and (2) using the extract as prophylactic agent. PBS was used as a negative control group. G. mellonella survival curves were plotted using the Kaplan–Meier method and statistical analysis was performed using the log-rank test (Mantel–Cox) and the significance level was set at (α ≤ 0.05). There was no significant difference among the groups in which all were biocompatible except of a significant death rate of 26.6% with nystatin 100%. In phase 1, it was found that after 7 days, there was no statistically significant difference among the prophylactic treatment groups. In phase 2, the groups of R. officinalis 6.25 mg/mL for 72 h and R. officinalis of 12.5 mg/mL for 24 h promoted the survival rate of the larvae in comparison with the control group with a significant difference (p = 0.017) and (p = 0.032) respectively. Therefore, R. officinalis extract is biocompatible in different concentrations and can be used as a prophylactic agent against fungal infection.

Comparison of Antifungal Activity of Jaftex Mouthwash and Nystatin Suspension against the Growth of Candida albicans.

Objective: Oral candidiasis is an opportunistic fungal infection in the oral cavity caused by an overgrowth of Candida species, especially Candida albicans. Various herbal agents have been designed to target Candida albicans. The aim of this study was to evaluate the antifungal activity of Jaftex mouthwash and nystatin suspension on the growth of Candida albicans. Materials and methods:In the present in vitro study, a standard strain of Candida albicans was prepared in the form of lyophilized ampoules. Jaftex mouthwash was prepared with an active ingredient (10 g per 100 cc) of aqueous extract of oak fruit hull (Jaft), Zataria multiflora and Satureja bachtiarica. Nystatin oral suspension (100,000 IU/mL) was also prepared. Both mouthwashes were serially diluted using the two-fold serial dilution method (Jaftex: eight-fold dilutions; nystatin suspension: nine-fold dilutions). A volume of 10 ìL of each dilution of Jaftex mouthwash and nystatin suspension was placed on the discs that were linearly inoculated on culture medium and stored in an incubator for 24 hours at 37 °C. The minimum inhibitory concentration (MIC) of the two antifungal agents was determined using the modified E-test. Data were analyzed using SPSS Version 26.0. A p-value less than 0.05 was considered statistically significant. Results:The mean MIC values of Jaftex mouthwash and nystatin suspension were 0.0625 (mg/mL) and 0.0015 (mg/mL), respectively. There was a significant difference between the antifungal effect of Jaftex mouthwash and nystatin suspension on the growth of Candida albicans. Nystatin showed the lowest MIC and greater antifungal activity compared with Jaftex mouthwash. Conclusion:Nystatin increasingly suppressed the growth of Candida albicans. Jaftex mouthwash inhibited the growth of Candida albicans. Since nystatin may show allergic reactions, Jaftex mouthwash can be used as an alternative to nystatin. Due to the synergistic effect of nystatin with thymol, Jaftex mouthwash can be prescribed with nystatin.

Medication-administration-via-enteral-feeding-tubes-a-survey-of-nurses-knowledge-and-practice

Introduction: Enteral feeding is a type of nutritional support for critically ill patients who are unable to tolerate oral feeding. It is vital to ensure that nurses practise proper administration techniques via enteral feeding tubes (EFT) to ensure that medications can be delivered safely and effectively. Objective: This study aims to assess the knowledge and practice of nurses on medication administration through EFT. The association between demographics and knowledge was also explored. Method: This study is a cross-sectional, self-administered, content-validated, pre-tested questionnaire survey involving all nurses who worked in the ward setting at Hospital Queen Elizabeth II from August to December 2020. Result: A total of 409 questionnaires were sent out with 252 responses received. The majority of respondents were female (n = 240, 95.6%) with a median working experience of 84 months (interquartile range of 44 months). Most nurses knew that the immediate-release dosage forms (n = 237, 94.4%) may be crushed and administered through EFT. Similarly, most nurses were aware that sublingual nitroglycerin (GTN) tablets should not be crushed (n = 232, 92.8%) and that nystatin suspension should not be administered via EFT (n = 212, 85.1%). However, about half of the nurses responded incorrectly when questioned about the particulars of EFT involving the administration of sustained-release medications (n = 152, 60.6%), soft gelatin capsules (n = 111, 44.4%) and hard gelatin capsules (n = 102, 40.6%). Meanwhile, in terms of practice, a majority of the nurses would correctly routinely flush the EFT before (n = 226, 90.4%) and after (n = 245, 98.8%) the administration of medications. However, only a small proportion of nurses (n = 43, 17.3%) demonstrated the appropriate practice of administering all medications separately all the time. Furthermore, it was also worth noting that for some specific knowledge-based questions, nurses from the intensive care setting had more correct responses when compared to those from the general ward setting (p < 0.05). Conclusion: The knowledge gap and inconsistencies in practices amongst nurses related to the use of EFT may lead to suboptimal delivery of medications, whilst potentially compromising patient outcomes. Hence, continuous educational programs should be carried out to ensure safe and effective drug administration through EFT.

Tolerability of Extended Multi-Drug Fungal Prophylaxis After Lung Transplant

<h3>Purpose</h3> Lung transplant patients are at risk of fungal infections post-transplant and require anti-fungal prophylaxis (AFP). However, utilization and duration of these agents can be limited by adverse effects. The purpose of this evaluation was to assess the tolerability and duration of AFP post-lung transplant at a large academic medical center. <h3>Methods</h3> This single-center retrospective review included lung transplant patients transplanted from August 2017 to August 2018 who received at least 7 days of AFP and were followed for three years. Patients received a combination of an azole anti-fungal agent, inhaled amphotericin B lipid complex (iABLC), and nystatin suspension immediately post-transplant. Pre-transplant colonization rates, prior fungal infections, transplant indication and baseline characteristics were collected. The primary outcome was tolerability of AFP. Secondary outcomes assessed were adherence and duration of AFP. <h3>Results</h3> Forty patients were included and one patient was excluded from the azole analysis due to a history of liver hyperplasia precluding therapy (Table 1). Patients remained on an azole, iABLC, and nystatin therapy a median of 13.9, 36.6, and 32 months post-transplant, respectively. The most common reason for AFP discontinuation was provider decision to end prophylaxis coverage (Table 2). Seven (19.4%) patients in the azole group, one (4.8%) patient in the iABLC group, and one (4.3%) patient in the nystatin group discontinued therapy due to intolerable side effects and adverse reactions. Patient reported adherence rates were highest in the azole group (87.2%), followed by iABLC (67.5%) and lowest with nystatin (45%). <h3>Conclusion</h3> Despite an extended duration of broad AFP, most patients tolerated therapy without limiting adverse effects. Oral AFP of shorter duration yielded the highest patient reported adherence.

Evaluation of oral mucositis in pediatric cancer patients in Hiwa Hospital in Sulaymaniyah city, Kurdistan Region, Iraq

Background and objective: Oral mucositis is caused by the destruction of the oral mucosal epithelium and suppression of its growth secondary to antineoplastic treatment in the form of chemotherapeutic drugs, substances, or radiotherapy. This study aimed to evaluate oral mucositis in pediatric cancer patients because it is one of the common side effects of cancer therapy that influences the outcome. Methods: This is a cross-sectional study that enrolled 100 pediatric patients with both hematological and non-hematological cancer. The age of the patients ranged from 1-18 years, involving both genders. Cases admitted to Hiwa hospital were clinically evaluated for oral mucositis, and ethical permission was taken from parents. Risk factors were assessed, including age, sex, cancer type, type of chemotherapy, radiotherapy, number of cycles, complete blood count, interleukin-1 beta, interleukin-6, tumor necrosis factor-alpha, and tumor necrosis factor-beta. Results: Baseline serum cytokines levels showed significant correlation between Interleukin-6 and intensity of the oral mucositis (P = 0.003, rho = 0.314) and no correlation between severity of oral mucositis with tumor necrosis factor-alpha, tumor necrosis factor-beta nor interleukin-1 beta (P = 0.140 and rho = 0.258, P = 0.463 and rho = -0.079, and P = 0.706 and rho = -0.041, respectively). There was significant relationship between Hemoglobin level, neutropenia and type of non-hematological cancer with the intensity of oral mucositis respectively (P ≤0.001 and rho = -0.352, P = 0.027 and rho = -0.221, and P = 0.035 and rho = 0.095, respectively). Correlation between age, gender, white blood cell count, platelet count, type of hematological malignancy and past history with the intensity of the oral mucositis did not show significant result. Conclusion: Intensity of oral mucositis increased with anemia, neutropenia, high interleukin-6 level, and the type of non-hematological cancer. It is recommended to treat anemic, neutropenic patients as soon as possible before exacerbating the mucositis. Methotrexate is the most aggressive drug alone and in combined chemotherapy agents, which may cause mucositis and needs prophylaxis like topical nystatin suspension or other methods. Keywords: Oral mucositis; Pediatric cancer; Non-hematological; Hematological; Sulaymaniyah.

Mechanical and antimicrobial effects of riboflavin-mediated photosensitization of in vitro C. albicans formed on polymethyl methacrylate resin

PurposeThis study assessed the potential of riboflavin-mediated photodynamic therapy (RF-PDT) against Candida albicans (C. albicans) and compared the effects of RF-PDT with other therapeutic modalities in terms of mechanical and surface characteristics of acrylic denture base material. Materials and methodsMolds (10 × 10 × 2 mm) of acrylic resin specimens were prepared and underwent artificial ageing. C. albicans were grown aerobically over the specimens and divided into four groups (n = 10/group); Group-I: no decontamination; Group-II: nystatin suspension; Group-III: riboflavin 0.1% in darkness, Group-IV: blue LED light only, and Group-V: riboflavin 0.1% for 10 minutes (pre-irradiation time) and photoactivated by the blue LED light (light dose). Fungal viability was assessed using MTT assay and characterized using scanning electron microscopy and confocal laser microscopy (CLSM). Treated specimens were subjected to surface roughness (Ra), flexural strength (FS), and flexural modulus (FM). ResultsGroup-I showed the highest C. albicans viability followed by Group-III. Nystatin group (Group-II) showed ∼50% of the viability while RF-PDT showed the least C. albicans viability among the four groups (p<0.05). On SEM, specimens treated with Group-IV and V showed almost clear and free from C. albicans that was evidenced on CLSM. Post-treated specimens and storage after 72 h revealed that FS was significantly higher for RF-PDT group as compared to any other group (>105.82 MPa) (p<0.05). The FM and Ra showed statistically no significant difference between the groups (p>0.05). ConclusionRF-PDT showed the highest anti-fungal capacity against C. albicans over acrylic denture surface without any surface deterioration.

Comparison of Antifungal Efficacy of Zataria Multiflora and Nystatin for Treatment of Denture Stomatitis: A Randomized Clinical Trial.

Statement of the Problem: Zataria multiflora (ZM) is a thyme-like plant that belongs to the Lamiaceae family. It is native to the center and south of Iran, Pakistan, and Afghanistan. Evidence shows that ZM contains thymol and carvacrol and is therefore, effective for the treatment of many conditions especially fungal infections. Oral candidiasis is the most common opportunistic infection of the oral mucosa that plays a role in the development of denture stomatitis.Purpose: This study aimed to compare the antifungal efficacy of ZM and nystatin suspension for the treatment of denture stomatitis.Materials and Method: This single-blind clinical trial evaluated 28 patients (> 18 years old) suffering from type II or III denture stomatitis. Patients were divided into two groups. The control group used nystatin suspension while the case group used ZM drop. The number of Candida albicans (C. albicans) colony-forming units (CFUs) and erythema of the palate were evaluated at baseline and at 14 days after treatment. Data were analyzed using SPSS version 11 via Student’s t test and repeated measure ANOVA.Results: The results showed similar efficacy of nystatin and ZM in the reduction of C.albicans CFUs compared to the baseline value (p= 0.593). Both medications significantly decreased the colony count (p< 0.001). Nystatin and ZM had similar efficacy for the reduction of erythema as well (p= 0.256) and both caused a significant reduction in erythema of the palate (p<0.001).Conclusion: ZM drop was as effective as the nystatin drop in the resolution of erythema of the palate and reduction of C. albicans colony count.

Fungicidal Effect of Lemongrass Essential Oil on Candida albicans Biofilm Pre-established on Maxillofacial Silicone Specimens.

ABSTRACTAims:This in-vitro study aimed to evaluate the efficacy of lemongrass (Cymbopogon citratus) essential oil in eradicating Candida albicans biofilm pre-established on the maxillofacial silicone specimens.Materials and Methods:Two maxillofacial silicones, namely, MDX4-4210 and Multisil Epithetik, were used for the fabrication of 6 mm diameter disks (n = 21 for each brand of silicone). A 48-h mature C. albicans ATCC 10231 biofilm was pre-established on sterile silicone specimen. These disks were then exposed to various concentrations of lemongrass essential oil ranging from 0.31% to 5% (v/v), 20% (v/v) nystatin, and RPMI-1640 medium for 18–20 h. After exposure, the remaining viable fungal biofilm was examined by the XTT [2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide]-reduction assay. All data were analyzed by using a regression coefficient and a post hoc Tukey HSD multiple comparisons test (α = 0.05).Results:Different brands of silicone used for fabrication did not significantly affect the formation of mature C. albicans biofilm (P =0.302). A 5% (v/v) lemongrass essential oil significantly eliminated fungal biofilm by approximately 95% (P =0.031). However, less than 50% of the fungal biofilm was eliminated by the tested oil at a concentration as low as 0.31% (v/v). Furthermore, the fungicidal efficacy against C. albicans biofilm of lemongrass essential oil at 2.5% (v/v) was as potent as that of 20% (v/v) nystatin suspension (P = 0.99).Conclusion:Lemongrass essential oil expressed fungicidal effect on C. albicans biofilm pre-established on the disks fabricated from different brands of silicone. Additionally, the fungicidal effectiveness of the oil against the mature fungal biofilm was dose-dependent.

Assessing The Knowledge and Attitudes of Group of Practicing Dentists in Saudi Arabia with Regards to Antifungal Prescriptions for The Treatment of Oral Candidiasis: A Cross-Sectional Study.

Introduction: Candida albicans is the most prevalent causative species of oral fungal infections. This study was designed to assess the knowledge of dentists who are practicing in a dental university hospital regarding antifungal prescriptions for the treatment of oral candidiasis in a Riyadh city, SA.&#x0D; Material and Methods: A self-administered questionnaire were distributed among dentists of different specialties to assess their knowledge and attitudes toward antifungal prescription for the treatment of oral candidiasis. Statistical analysis was carried out to describe the properties of the sample in terms of frequencies and distribution while chi square test was used to compare the results between groups at level of significant P value ≤0.05 using the Statistical Packages for the Social Science (SPSS) Program.&#x0D; Results: A total of 130 completed questionnaires were received. Males contributed 55.4% compared to 44.6% female counterparts. Topical antifungals were preferred by 85.4% of the participants. Topical Nystatin and oral fluconazole were the chosen antifungal agents by the dentists for the treatment of local (55.4%) and systemic (58.4%) fungal infections respectively. The challenge that was faced by most respondents (46%) is the lack of knowledge about the recommended dosage to be prescribed. Also, a significant difference in the knowledge was detected between dentists of different specialties.&#x0D; Conclusion: Most dentists will start with topical antifungal agents, nystatin suspension is the first medication of choice follow by miconazole and for the systemic antifungal agents oral fluconazole is first medication of choice. As for the adjunctive therapy most participants prescribed 0.2% chlorhexidine gluconate mouthwash.

Treatment of oropharyngeal candidiasis in immunocompetent and immunocompromised patients

Treatment of oropharyngeal candidiasis in immunocompetent and immunocompromised patients

Efficacy of Camellia sinensis extract against Candida species in patients with denture stomatitis.

Background and Purpose:Denture stomatitis is a chronic inflammation disease of the oral mucosa, which is specified by erythematous lesions mainly in the upper palate. Nystatin as a polyene, a class of antifungal agents, is one of the effective drugs to treat denture stomatitis. Considering the expansion of utilizing herbal drugs to cure many kinds of diseases, the present study was conducted to investigate the effects of Camellia sinensis (green tea), which has the most chemical and influence similarity with nystatin, against denture stomatitis.Materials and Methods:This study was conducted on 22 patients with a positive mycological evidence for denture stomatitis caused by Candida species. The study population was divided into two groups, namely green tea and nystatin, receiving green tea mouthwash 0.5% and nystatin suspension 100,000 U/ml, respectively. The lesion size and number of yeast colonies were measured before and after the treatment.Results: According to the results, both groups showed reduced lesion size, clinical improvement, and significant reduction of Candida colony count in both group of patients were showedafter the therapeutic. Based on the results of polymerase chain reaction, Candida albicans was the most common species isolated from denture stomatitis. There was no significant difference between the two study groups in terms of Candida species distribution (P=0.700).Conclusion: Green tea demonstrated a comparable anti-Candida activity with regard to nystatin; therefore, it could be recommended as an alternative treatment.

Development of a gum base formulation for nystatin; a new drug delivery approach for treatment of oral candidiasis

The purpose of this work is to develop a new formulation of nystatin using chewing gum as a drug delivery system to optimize the drug release rate in order to improve the desired efficacy in the site of action for treating patients with oral candidiasis. Medical chewing gum is a pleasant and highly convenient method of administration for almost all groups of patients. Nystatin is an antifungal drug with very low solubility in water. When the drug was formulated alone in chewing gum, its release rate was very low. To increase its aqueous solubility and release rate from the chewing gum, polyethylene glycol 4000 and 400 were used as solubilizing agents. Nystatin formulations were prepared as a solid dispersion with PEG-4000 and simple dispersion with PEG-400 and incorporated into the chewing gum. The results of the solubility studies with shake-flask method indicated that the apparent solubility of nystatin increased significantly up to 4.3 mg/ml and 2.6 mg/ml with PEG-4000 and PEG-400 respectively in phosphate buffer pH 6.8. In vitro dissolution studies were performed by a mastication device, demonstrating that the nystatin-PEG4000 solid dispersion formulation through the chewing gum had extended and complete release rate. The results obtained here suggested that the nystatin chewing gum was more efficacious than the commercial nystatin suspension, and the optimized formulation had also good stability.

Abstract P4-16-01: Evaluation of miracle mouthwash (MMW) plus hydrocortisone or prednisolone mouth rinses as prophylaxis for everolimus-associated stomatitis: Results of a randomized phase II study

Abstract Background: Oral stomatitis is a frequent adverse event (AE) associated with mTOR-inhibitor therapy, and can impact adherence. In BOLERO-2, patients (pts) with hormone receptor-positive (HR+) metastatic breast cancer (MBC) treated with exemestane plus everolimus (EVE), the incidence of all-grade (G) stomatitis or related AEs was 67%, with 24%/8% of pts developing G2/G3 stomatitis or related AEs, respectively (Perez et al ASCO 2013 Abs 7029). In BOLERO-2, 24% of pts required EVE dose reduction for stomatitis (Rugo et al Ann Oncol 2014;25:808). This study evaluated 2 steroid-based mouth rinses for the prevention or amelioration of oral stomatitis in pts with MBC treated with EVE. Methods: This prospective randomized phase II study enrolled postmenopausal pts (planned accrual=100) with HR+ MBC within the US Oncology Network who were initiating therapy with an aromatase inhibitor plus EVE (10 mg/day)(AIE). Pts were randomized 1:1 to prophylactic therapy with 1 of 2 oral rinses (ARM 1: MMW 480 ml recipe: 320 mL oral Benadryl, 2 g Tetracycline, 80 mg Hydrocortisone, 40 mL Nystatin suspension, water; or ARM 2: Prednisolone (P) 15mg/5mL oral solution, 1.8% alcohol). Pts were instructed to swish/expectorate 10 ml of the assigned rinse 4x daily starting with D1 of EVE treatment, for a total of 12 wks. The primary objective was to determine the incidence of G≥2 stomatitis or related oral AEs during the first 12 wks of treatment. Based on a historical estimate that ≥37% of pts receiving AIE develop G≥2 stomatitis, 50 pts for each arm were required to detect a reduction of the incidence of G≥2 stomatitis from 37% to &amp;lt;20%, with alpha = 0.05, 80% power, and a 1-sided test. Secondary objectives included assessment of AEs (all grades), determination of the percentage of pts requiring dose interruption/reduction of EVE or discontinuation of therapy due to toxicity, and evaluation of the impact of the oral rinses on the duration and severity of stomatitis. Results: As of 5/30/2016, a total of 104 pts have been randomized and 100 pts have received treatment (49 MMW; 51 P). Median age was 61 yrs (range 31-82 yrs). The incidence of stomatitis and related oral AEs (any grade) during the first 12 wks was 29% (n=14/49) and 27.5% (14/51) in the MMW and P arms respectively. The incidence of G2 oral AEs was 12% (6/49) and 8% (4/51) with MMW and P respectively. There was only 1 G3 oral AE (MMW arm), and no G4 events. There was 1 EVE dose reduction (MMW) and 4 EVE dose delays (3 MMW, 1 P) during the first 12 wks of treatment. No pts stopped the steroid mouth rinse therapy due to mouth rinse-related toxicity. Conclusion: These prospective data provide evidence of a reduced incidence of mTOR-associated oral AEs with prophylactic use of a steroid mouth rinse. The 29%/27.5% incidence of all-grade and 12%/8% incidence of G2 oral AEs, with only 1 G3 event, compare favorably with the 67% and 24%/8% incidence of all-grade and G2/3 stomatitis, respectively, in BOLERO-2. These data also show the safety and tolerability of these 2 steroid mouth rinses. Prophylactic use of steroid mouth rinses substantially decreases the incidence of G2/3 stomatitis and the need for EVE dose modifications. Citation Format: Jones VE, McIntyre KJ, Paul D, Wilks ST, Ondreyco SM, Sedlacek SM, Melnyk Jr. AM, Oommen SP, Wang Y, O'Shaughnessy JA. Evaluation of miracle mouthwash (MMW) plus hydrocortisone or prednisolone mouth rinses as prophylaxis for everolimus-associated stomatitis: Results of a randomized phase II study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-16-01.

Comparative Evaluation of Antifungal Activity of Piper Betel Leaf Oil, Origanum vulgare Essential Oil and Fluconazole Suspension on Candida albicans − An In Vitro Study

Introduction: Oropharyngeal candidiasis is an opportunistic mucosal infection caused by Candida albicans. It usually responds to topical treatments such as clotrimazole troches, topical fluconazole, chlorhexidine mouthwash and nystatin suspension. Piper betel leaf oil and Origanum vulgare essential oil have shown some topical antifungal activity. Aim: To determine and compare the antifungal efficacy of piper betel leaf oil, O. vulgare essential oil and fluconazole suspension against C. albicans. Materials and Methods: The zone of inhibition was measured by the cup–plate diffusion method using 100 μl volume of piper betel leaf oil, O. vulgare essential oil and fluconazole suspension, which were pipetted into the wells of the inoculated Sabouraud’s dextrose agar plates. The zone of inhibition was measured in millimetres using Vernier calliper. Minimum inhibitory concentration (MIC) was determined by the broth macro-dilution test by pouring 1 ml of the respective concentrations of the test material to the individual test tubes along with 10 μl of the diluted test organism inoculum. Finally, MIC was calculated using a reflective viewer. Results: The zone of inhibition for O. vulgare essential oil (>40 mm) was more than fluconazole suspension (>35 mm). MIC of O. vulgare essential oil, piper betel leaf oil and fluconazole suspension was 1.6%, 0.4% and 0.8%, respectively. Conclusion: O. vulgare essential oil was found to be a more effective antifungal agent than piper betel leaf oil and fluconazole suspension.

In vivo study of antifungal effects of low-molecular-weight chitosan against Candida albicans.

This study investigated the antifungal effects of low-molecular-weight chitosan solution on Candida albicans in denture stomatitis in comparison with nystatin suspension. This randomized, sing-leblind clinical trial included 40 patients diagnosed with denture stomatitis. Patients were divided into two groups, wherein one was treated with chitosan and the other with nystatin for 2 weeks. Changes in the erythematous area were recorded during and after treatment. A palatal smear was obtained for each patient before and after treatment to determine the number of blastospores and mycelia of C. albicans. The results were compared using the Mann-Whitney U test, revealing that the chitosan solution significantly decreased the erythematous surface area, burning sensation, time required for clinical improvement, and number of blastospores and mycelia. The antifungal efficacy of chitosan along with its inherent biocompatibility makes it a promising candidate for use as an antifungal mouthwash.