Commercial mouthwashes are more effective than azole antifungals against Candida albicans biofilms in vitro

Objective. The aim of this study was to evaluate and compare the activity of prescription and over-the-counter antimicrobial compounds against planktonic and biofilm forms of Candida albicans isolated from cases of oral candidiasis in vitro. Study design. The efficacy of azoles, polyenes, an echinocandin, and 4 over-the-counter mouthwashes were tested against C. albicans-derived planktonic and biofilm cells. Results. Planktonic cells were shown to be highly sensitive to all of the antifungal agents tested. Sessile cells were highly resistant to azoles (>= 128 mg/L) but equally sensitive to caspofungin and short treatments with Corsodyl, Listerine, and Oraldene. Conclusions. Although C. albicans is sensitive to azole antifungal agents in planktonic form, it is highly resistant within the biofilm. The good efficacy of the over-the-counter mouthwashes against candidal biofilms in vitro suggests that clinical trials should now be designed to establish their role in the clinical management of oral candidal infections. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:456-460)