Natural Compounds with Antimicrobial Activities in Oral Candida Infections during Head and Neck Radiotherapy

Chemotherapy. 2024;69(2):65-84. doi: 10.1159/000534562. Epub 2023 Nov 14.


Background: Oral colonization and infections are frequently observed in patients during and soon after radiation therapy. Infective mucositis is a common side effect associated with cancer therapy, characterized by an inflammation of the oral mucous membranes with histological mucosal and submucosal changes. Ulcerative mucositis is responsible for significant pain, impairing the patient's nutritional intake and leading to local or systemic infections promoting mycosis due to several species of the genus Candida. According to international guidelines, treatment of candidiasis depends on the infection site and patient's condition.

Summary: Recently, several studies have shown the protective role of natural compounds counteracting the activity of Candida biofilms. The aim of this review was to discuss the antimicrobial activities of natural compounds in fungal infections, especially Candida spp., during and soon after radiotherapy. Indeed new molecules are being discovered and assessed for their capacity to control Candida spp. growth and, probably in the future, will be used to treat oral candidiasis, overall, during radiotherapy. This review reports several preliminary data about preclinical and clinical evidence of their efficacy in the prevention and/or treatment of mucositis due to radiotherapy with a brief description of the natural compounds with anti-Candida activities.

Key messages: The increase in the resistance to the available antifungal drugs related to Candida spp. infections increased as well as drug interactions, urging the development of innovative and more effective agents with antifungal action. Recent preclinical and clinical studies are identifying natural substances with anti-inflammatory and antifungal activity that could be tested in the prevention of candidiasis in patients undergoing radiotherapy. Further studies are needed to confirm these preliminary data.

Keywords: Candida species; Fungal infections; Mucositis; Natural compounds; Radiotherapy.

Publication types

  • Review

MeSH terms

  • Antifungal Agents* / pharmacology
  • Antifungal Agents* / therapeutic use
  • Biofilms / drug effects
  • Biofilms / radiation effects
  • Biological Products / pharmacology
  • Biological Products / therapeutic use
  • Candida* / drug effects
  • Candidiasis, Oral* / drug therapy
  • Candidiasis, Oral* / etiology
  • Head and Neck Neoplasms* / drug therapy
  • Head and Neck Neoplasms* / radiotherapy
  • Humans


  • Antifungal Agents
  • Biological Products