Evaluation and comparison of antifungal effect of voriconazole with nystatin on candida species derived from neoplastic patients undergoing maxillofacial radiotherapy

Radiotherapy is a common treatment for head‑and‑neck malignancies and causes complications such as oral candidiasis and the change of oral Candida species from albicans to nonalbicans. Voriconazole has acceptable antifungal effect. The aim of this study was to determine and compare the antifungal effect of nystatin with voriconazole on these species.

The samples used in this in vitro study were identified by polymerase chain reaction‑restriction fragment length polymorphism from patients before and 2 weeks after head‑and‑neck radiotherapy in Seyed Al‑Shohada Hospital. The antifungal effect of nystatin and voriconazole was determined by microdilution method and measurement of the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration, and the results were analyzed by Mann–Whitney analysis.

The results showed that all species before and after radiotherapy showed 100% sensitivity to nystatin. Prior to radiotherapy, 57.1% of albicans species isolated were in the sensitive range (MIC ≤1) and 42.9% were in the dose‑dependent range (MIC = 2) to voriconazole. After radiotherapy, 58.3% of albicans species were in the sensitive range and 41.7% of these species were in the dose‑dependent range to voriconazole.

The results of the present study showed that before radiotherapy, all species were sensitive to nystatin, while a percentage of albicans and nonalbicans were resistant to voriconazole. In the 2nd week of radiotherapy similar to prior to radiotherapy, all species isolated from patients were sensitive to nystatin, while a percentage of albicans and nonalbicans were resistant to voriconazole.