A Three Part Over the Counter Intervention Induces Remission or Improvement in Chronic Oropharyngeal Candidiasis
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Cosby A Stone, MD, MPH, Jane J. Choi, MD
Rationale: Oropharyngeal candidiasis is a painful condition with frequent relapses. Antibiotic containing oral products may be a risk factor favoring Candida over other species. 

Methods: In 8 patients with oropharyngeal candidiasis demonstrated by physical examination or direct laryngoscopy, we assessed use of antibiotic containing oral care products, inhaled corticosteroids, systemic antibiotics, and the presence of immune suppression. We then discontinued antibiotic containing oral care products, added daily liquid probiotic consumption (kefir yogurt), and encouraged oral rinses with dilute baking soda for two weeks, after which fluconazole or nystatin therapy was added.

Results: Antibiotic containing toothpaste use was present in 100% of our cases, with triclosan being the most common antibiotic (88%). Use of inhaled corticosteroids (50%), immune suppression (25%) and recent systemic antibiotic use (25%) were also common. 50% of patients achieved resolution of oropharyngeal candidiasis by intervention alone and 50% achieved remission with addition of antifungal medication. 100% reported symptomatic reduction with the intervention. Continuing the intervention, 4 out of 8 patients were able to tolerate subsequent oral antibiotic exposure without recurrence of oropharyngeal candidiasis, 1 had symptoms return with lower severity, and 3 have not yet required antibiotics. Importantly, two patients who had lived with >2 years of persistent daily candidiasis achieved remission without antifungal treatment. 

Conclusions: Use of antibiotic containing oral care products is common in patients with oropharyngeal candidiasis. Cessation of antibiotic containing oral care products along with addition of probiotic kefir yogurt and rinses with dilute baking soda helps achieve remission or symptom reduction.