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Background  Limitations of antifungal agents used in the treatment of oral candidiasis, as the development of resistant strains, are known by the scientific community. In this context, the aim of this study was to evaluate the antifungal activity of thymol against  Candida albicans, Candida tropicalis  and  Candida krusei  strains and to determine its mode of action and synergistic effect when combined with the synthetic antifungal nystatin.    Methods  The minimum inhibitory concentration (MIC) was determined using a microdilution technique, and the minimum fungicidal concentration (MFC) was determined via subculture sowing. The mode of action of thymol was established by verifying fungal growth in the presence of sorbitol or ergosterol. The fractional inhibitory concentration index (FIC) was determined using the checkerboard method.    Results  Thymol presented an antifungal effect, with MICs of 39 μg/mL for  C. albicans  and  C. krusei  and 78 μg/mL for  C. tropicalis . The results of the antifungal test remained unchanged in the presence of sorbitol; however, the MIC value of thymol against  C. albicans  increased eight times (from 39.0 to 312.5 μg/mL) in presence of exogenous ergosterol. The combination of thymol and nystatin reduced the MIC values of both products by 87.4 %, generating an FIC index of 0.25.    Conclusions  Thymol was found to have a fungicidal effect on  Candida  species and a synergistic effect when combined with nystatin.

bmc complementary and alternative medicine

Antifungal activity and mode of action of thymol and its synergism with nystatin against Candida species involved with infections in the oral cavity: an in vitro study