Anti-adherence and Anti-fungal Abilities of Thymol and Carvacrol Against Candida Species Isolated From Patients with Oral Candidiasis in Comparison with Fluconazole and Voriconazole

Background: Natural isopropyl cresols, such as thymol and carvacrol, have been known to have antifungal activities. Objectives: The current study aimed to investigate the anti-adherence and antifungal activities of thymol, carvacrol, fluconazole, and voriconazole against oral isolates of Candida albicans (C. albicans), C. glabrata, and C. krusei. Methods: The susceptibility assay for the test compounds was performed using the disk diffusion method against all Candida isolates. Also, anti-adherence activity was examined using a rapid and highly reproducible 96 well microtiter-based method. Results: Both natural phenols and antifungal drugs revealed various efficacies against studied Candida species. The susceptibility to fluconazole and voriconazole were 100% for C. albicans, 50% and 90% for C. glabrata, and 0% and 100% for C. krusei isolates, respectively. The mean diameter of the inhibition zone was greater for thymol than carvacrol in C. albicans (19.89 +/- 0.80 mm versus 17.05 +/- 0.61 mm), C. glabrata (18.87 +/- 0.71 mm versus 15.77 +/- 0.57 mm), and C. krusei (15.11 +/- 0.91 mm versus 13.91 +/- 1.04 mm) isolates tested. Thymol showed more effective inhibition on adherence of all Candida species than other treatments. The mean relative adherence ratios for C. albicans, C. glabrata, and C. krusei were 0.50, 0.60, and 0.64, respectively. Conclusions: This study demonstrated significant inhibitory properties of thymol and carvacrol on the adherence and growth of azole susceptible- and -resistant Candida isolates. Also, thymol was more effective for preventing the adherence of yeast cells to polystyrene in comparison to carvacrol.