In-vitro Antifungal Activities of Kombucha Tea Culture Supernatant Combined with Voriconazole against Vulvovaginal Candidiasis Clinical Isolates

Objective: To investigate the antifungal activity of voriconazole, with and without Kombucha tea culture, against Candida strains isolated from vulvovaginal candidiasis. Material and Methods: The study included 150 females, within child-bearing periods, complaining of valvovaginal candidiasis. Candida strains were isolated, and identified by conventional microbiological methods; and confirmed by Viteck-2 System. The sensitivity of the isolates to voriconazole was performed, via the Disc diffusion method. Resistant strains were then subjected to minimum inhibitory concentrations (MIC) investigation of voriconazole alone, and in combination with a Kombucha tea culture via the broth micro-dilution method in concentrations ranging from 0.0048 to 10 μg/ml. The ability of voriconazole, with and without Kombucha, to eradicate Candida biofilms were investigated using a crystal violet absorbance assay. Results: Eighty-nine strains were isolated. From these 60 isolates showed variable resistance patterns (57 were voriconazole resistant, and 3 had dose-dependent susceptability). Kombucha significantly decreased the MIC50 of voriconazole against all strains from 5 to 0.625 μg/ml (p-value<0.01); additionally, MIC90 were reduced from 10 to 1.25 μg/ml (p-value =0.000). Voriconazole at a concentration of 0.156 μg/ml succeeded in eradicating biofilms formed by 18 strains after adding a Kombucha tea supernatant versus zero strains when using Voriconazole alone. Conclusion: Kombucha Black tea cultures could be promising antifungal agents in the treatment of vulvovaginal candidiasis.