Overcoming Antifungal Resistance in Oral Candida albicans: Mechanistic Insights and Future Therapeutic Perspectives
Christabel Maureen Vitaley Sung1, Astari Puteri2*
Abstract
Oral candidiasis is a common opportunistic fungal infection most frequently associated with Candida albicans, particularly in immunocompromised individuals and patients with recurrent or persistent oral infection. Although antifungal agents such as polyenes, azoles, echinocandins, and flucytosine remain important in clinical management, their effectiveness may be limited by reduced susceptibility and the emergence of antifungal resistance. This narrative review discusses the mechanisms underlying antifungal resistance in oral C. albicans and explores potential mechanism-guided therapeutic strategies. Resistance in C. albicans involves multiple interconnected mechanisms, including antifungal target alteration, efflux pump overexpression, ergosterol pathway modification, membrane remodelling, cell wall adaptation, impaired drug metabolism, and adaptive stress-response pathways. In the oral microenvironment, biofilm-associated tolerance further contributes to treatment difficulty by limiting antifungal penetration, protecting fungal cells, and supporting persistent or recurrent infection. Therefore, future strategies should not rely solely on conventional antifungal use but should also consider antifungal susceptibility testing, optimisation of existing therapy, combination therapy, anti-biofilm approaches, alternative antifungal agents, and improved local drug delivery systems. A better understanding of resistance mechanisms and biofilm-associated tolerance may support the development of more targeted and effective therapeutic strategies for oral candidiasis.
Keywords
antifungal agents; antifungal drug resistance; biofilms; candida albicans; oral candidiasis
Cite This Article
Sung, C. M. V., Puteri, A. (2026). Overcoming Antifungal Resistance in Oral Candida albicans: Mechanistic Insights and Future Therapeutic Perspectives. International Journal of Scientific Advances (IJSCIA), Volume 7| Issue 3: May – Jun 2026, Pages 421-427 URL: https://www.ijscia.com/wp-content/uploads/2026/06/Volume7-Issue3-May-Jun-No.1057-421-427.pdf
Volume 7 | Issue 3: May – Jun 2026
