Efficacy of Botanical Antifungal and Conventional Antifungal in the Treatment of Oral Candidiasis: A Systematic Review and Meta-Analysis

Nurdiana Nurdiana¹Supawadee Naorungroj^2,3*Kraisorn Sappayatosok^4*Luelak Lomlim⁵Nuntiya Pahumunto^3,6

• ¹Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand
• ²Department of Conservative Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand
• ³Research Center of Excellence for Oral Health, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand
• ⁴College of Dental Medicine, Rangsit University, Pathum Thani, Thailand
• ⁵Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Science, Prince of Songkla University, Hat Yai, Songkhla, Thailand
• ⁶Department of Oral Diagnostic Sciences, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand

Background: The use of botanical drugs for treating various disorders has gained increasing attention in recent years, with many studies highlighting the efficacy of botanical antifungals against oral candidiasis. However, there is no definitive evidence indicating whether the botanical antifungals have superior or inferior efficacy compared to the conventional antifungals. This systematic review and meta-analysis evaluated the effectiveness of herbal and botanical antifungals versus conventional antifungals in treating oral candidiasis. This is the first pairwise comparison of the clinical efficacy. Methods: From inception to June 2024, PubMed, EMBASE, Scopus, and Web of Science were searched for randomized clinical trials published in English that investigated botanical antifungals compared to conventional antifungals in treating oral candidiasis. The primary outcome was lesion improvement, with in vitro Candida examination as the additional outcome. The lesion improvements were defined as the treatment duration (≤15 days and >15 days). Three independent reviewers screened the papers, and quality was assessed using Cochrane's Risk of Bias 2 tools. For the Risk of Bias, five domains were evaluated and classified into three categories: low risk, some concerns, and high risk. A meta-analysis was conducted using STATA version 16 (Texas, USA). The protocol was registered in PROSPERO with an ID of CRD42024589391. Results: From 1595 studies identified, 10 trials were included with 426 patients, and 13 botanical drugs were studied. Half (50%) of the included studies had a low risk of bias. Three (30%) studies showed higher efficacy of botanical antifungals, five (50%) studies showed comparable results, and two (20%) studies showed higher efficacy of conventional antifungals in lesion improvement of oral candidiasis. The meta-analysis with random-effects analysis, which encompassed five studies involving 278 patients, revealed no significant difference in lesion improvement for oral candidiasis between botanical and conventional antifungals. The relative risk (RR) was calculated at 0.99, with a 95% confidence interval (CI) of (0.63, 1.56). Conclusion: Based on the limited evidence, botanical antifungals have comparable efficacy to conventional antifungals in treating oral candidiasis. Therefore, they may serve as adjunctive or alternative treatments.