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

• Published in: Supportive care in cancer 2013-11, Vol.21 (11), p.3191-3207
• Main Authors: Saunders, Deborah P., Epstein, Joel B., Elad, Sharon, Allemano, Justin, Bossi, Paolo, van de Wetering, Marianne D., Rao, Nikhil G., Potting, Carin, Cheng, Karis K., Freidank, Annette, Brennan, Michael T., Bowen, Joanne, Dennis, Kristopher, Lalla, Rajesh V.
• Format: Article
• Language: English
• Subjects: Analgesics - therapeutic use; Anesthetics; Anesthetics - therapeutic use; Anti-infective agents; Anti-Infective Agents - therapeutic use; Anti-Ulcer Agents - therapeutic use; Cancer patients; Cancer therapies; Care and treatment; Chemoradiotherapy - adverse effects; Coatings; Drug therapy; Evidence-based medicine; Head and Neck Neoplasms - complications; Head and Neck Neoplasms - therapy; Hematopoietic stem cells; Humans; Medicine; Medicine & Public Health; Morphine; Mouth; Mucous membrane; Nursing; Nursing Research; Oncology; Pain management; Pain Medicine; Practice guidelines (Medicine); Practice Guidelines as Topic; Rehabilitation Medicine; Review Article; Side effects; Stomatitis; Stomatitis - drug therapy; Stomatitis - prevention & control; Sucralfate - therapeutic use; Systematic review; Transplantation
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-013-1871-y

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.