GV Mouthwash for the Treatment of Oral Candidosis in Malawi and Vietnam

1Melbourne Dental School, The University of Melbourne, Vic, Australia. 2UCL Eastman Dental Institute and UCLHT Eastman Dental Hospital, London UK. 3National Hospital of Odonto-Stomatolgy, HCMC, Vietnam. 4Department of Paediatrics, College of Medicine, Blantyre, Malawi. 5Section of Public Health & Health Policy, University of Glasgow, UK. 6Faculty of Odonto-Stomatology, University of Health Science in HCMC, Vietnam. 7Parasito-Mycology Dept., University Pham Ngoc Thach of Medicine, HCMC

OBJECTIVES: Oral and oro-pharyngeal candidosis are common opportunistic infections in both malnourished and immunosuppressed patients. Gentian violet (GV) mouth rinse is recommended as first line treatment by WHO for patients in resource poor countries, however there is little published evidence to support its effectiveness. We have assessed the clinical and mycological effectiveness of GV in three separate clinical trials.

METHODS: TRIAL ONE: Longitudinal study of strains isolated from 49 HIV-positive children in Malawi (2-56 weeks), 1% GV as mouthwash. TRIAL TWO: Three-armed randomised control trial of a 10-day treatment with either 1% GV, 0.00165% GV or nystatin (100,000 IU/ml), 1042 patients enrolled, 450 assessed day 12 and 312 day 21. TRIAL THREE: Randomised, placebo-control 6 week trial of 0.05% GV Vs 0.0005% GV in 115 adult HIV infected patients with clinically evident oral candidosis in HCMC, Vietnam. linical (visual) and mycological (CFU/ml; species by PCR and MIC by broth micro-dilution) parameters assessed.

RESULTS: TRIAL ONE; Clinical efficacy of GV demonstrated, well tolerated, mucosal staining significant, no other adverse reaction, 26 (53.1%) patients harboured oral yeasts, 78% (67/87) of isolates Candida albicans, no resistance developed, highest MIC 16.5 µg/ml. TRIAL TWO: No significant difference between three arms for either clinical cure (no clinically visible lesions) and mycological cure (zero CFU). Weak GV (0.00165%) showed less mucosal staining. TRIAL THREE; 81% (69/85) patients showed clinical cure at 6 weeks for both GV, placebo 0% (30/30). Mycological response; 71% (81/115) had over 200 CFU/ml isolated at week 0; 10% (9/85) over 200 CFU/ml for both GV, 67% (20/30) for placebo at 6 weeks.

CONCLUSION: GV mouthwash, at low concentrations (0.0005%, 5 µg/ml), has good microbiological and clinical outcomes as a cheap topical antifungal agent with significance impact on the clinical management and prophylaxis of oral Candida infections in resource-poor countries.