Resistance of Oral Candida albicans Infection to Fluconazole and Nystatin among Healthy Persons after Treatment with Azithromycin and Hydroxychloroquine to Treat Suspected SARS-COV-2 Viral Infection

Abstract

Background: Oral candidiasis is considered the most common fungal infection in humans. Polyene or azole antifungal drugs can be used for Candida infection. In addition, Nystatin therapy is used in mild forms of oral candidiasis. However, the current literature reports conflicting results regarding azithromycin and hydroxychloroquine for COVID-19. Objective: We aim to evaluate the resistance of oral Candida albicans to fluconazole and nystatin in healthy individuals who have received therapy for suspected COVID-19 with azithromycin and hydroxychloroquine. Methodology: The current case-control study collected samples of oral candidiasis from two types of patients. The cases group (group 1) were patients with confirmed COVID-19; the control group (group 2) were healthy controls without previous COVID-19. The antifungal susceptibility was examined based on the principles of M44-A suggested by the Clinical and Laboratory Standards Institute (CLSI). Results: Thirty patients were included in the cases group. In terms of the antifungal susceptibility between the study groups, the study showed the details of fluconazole and nystatin resistance. Fluconazole resistance was detected significantly higher in 86.7% of the cases group compared with only 56.7% of the subjects in the control group (P=0.010). Similarly, nystatin resistance was significantly higher in 76.7% of the cases group, while the control group showed 23.3% drug resistance (P< 0.001). Conclusion: Treating COVID-19 patients with hydroxychloroquine and azithromycin negatively impacted the antimicrobial resistance (AMR) of oral candidiasis. Given the limited efficacy of both treatments, avoiding the broad-spectrum use of both agents in managing COVID-19 patients is advisable.