Systemic antifungal therapy reshapes the gut microbiome in some IBD patients

A Nature Medicine study from Weill Cornell compared two weeks of fluconazole (systemic) vs nystatin (mouthwash) in 53 IBD patients with oral thrush. Fluconazole reduced intestinal Candida, remodeled gut fungal and bacterial communities, increased bacterial diversity and butyrate production, and was associated with lower disease activity and slower progression over eight weeks, unlike nystatin. The trial was not randomized or placebo-controlled, so findings are preliminary and justify a larger multicenter trial to confirm efficacy and explore broader patient applicability.