Fluconazole and Ibuprofen: A Challenge for Combined Treatment of Mucosal Candidiasis

The incidence of drug-resistant candidiasis has increased dramatically.This study aimed to evaluate antifungal effects of fluconazole alone and in combination with ibuprofen on isolates from patients with mucosal candidiasis.

Candida species isolated from 142 patients with suspected mucosal (oral and vaginal) candidiasis were identified by culture on CHROMagar Candida medium and carbohydrate assimilation test using the API 20CAUX kit. Minimum inhibitory concentration (MIC) of fluconazole alone and in combination with ibuprofen was determined by the broth microdilution method.

Among isolates, 43.7% were identified as Candida species (Candida albicans, Candida glabrata, Candidia parapsilosis, Candida tropicalis, Candida guilliermondii and Candida kefyr). The highest rate of fluconazole resistance was observed among C. albicans (50%) and C. parapsilosis (4.8%) isolates. MIC90 of ibuprofen-fluconazole combination against C. albicans isolates was 32 μg/mL, which was 8-fold less than that of fluconazole alone (MIC90= 256μg/mL) (P<0.01). Moreover, the MIC90 of fluconazole-ibuprofen combination against C. parapsilosis isolates was 4-fold less than that of fluconazole alone.

Our results revealed partial fluconazole resistance among Candida isolates from patients with mucosal candidiasis. However, the resistance rate reduced 2.5 fold following treatment with the ibuprofen-fluconazole combination. Therefore, it is recommended to further investigate the therapeutic potential of this drug combination for treatment of fungal infections, such as candidiasis.