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Supportive Care in Cancer
Published in: Supportive Care in Cancer 11/2013

01-11-2013 | Review Article

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients

Authors: Deborah P. Saunders, Joel B. Epstein, Sharon Elad, Justin Allemano, Paolo Bossi, Marianne D. van de Wetering, Nikhil G. Rao, Carin Potting, Karis K. Cheng, Annette Freidank, Michael T. Brennan, Joanne Bowen, Kristopher Dennis, Rajesh V. Lalla, For The Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO)

Published in: Supportive Care in Cancer | Issue 11/2013

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Abstract

Purpose

The aim of this project was to develop clinical practice guidelines on the use of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the prevention and management of oral mucositis (OM) in cancer patients.

Methods

A systematic review of the available literature was conducted. The body of evidence for the use of each agent, in each setting, was assigned a level of evidence. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, or no guideline possible.

Results

A recommendation was developed in favor of patient-controlled analgesia with morphine in hematopoietic stem cell transplant (HSCT) patients. Suggestions were developed in favor of transdermal fentanyl in standard dose chemotherapy and HSCT patients and morphine mouth rinse and doxepin rinse in head and neck radiation therapy (H&N RT) patients. Recommendations were developed against the use of topical antimicrobial agents for the prevention of mucositis. These included recommendations against the use of iseganan for mucositis prevention in HSCT and H&N RT and against the use of antimicrobial lozenges (polymyxin–tobramycin–amphotericin B lozenges/paste and bacitracin–clotrimazole–gentamicin lozenges) for mucositis prevention in H&N RT. Recommendations were developed against the use of the mucosal coating agent sucralfate for the prevention or treatment of chemotherapy-induced or radiation-induced OM. No guidelines were possible for any other agent due to insufficient and/or conflicting evidence.

Conclusion

Additional well-designed research is needed on prevention and management approaches for OM.
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Metadata
Title
Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients
Authors
Deborah P. Saunders
Joel B. Epstein
Sharon Elad
Justin Allemano
Paolo Bossi
Marianne D. van de Wetering
Nikhil G. Rao
Carin Potting
Karis K. Cheng
Annette Freidank
Michael T. Brennan
Joanne Bowen
Kristopher Dennis
Rajesh V. Lalla
For The Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO)
Publication date
01-11-2013
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 11/2013
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-013-1871-y

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