title: Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Additional well-designed research is needed on prevention and management approaches for OM.
authors.affiliation: Department of Dental Oncology, North East Cancer Center, Health Sciences North, Sudbury, Ontario, Canada, dsaunders@hsnsudbury.ca.
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Saunders
authors.forename: Joel B
authors.initials: JB
authors.lastname: Epstein
authors.forename: Sharon
authors.initials: S
authors.lastname: Elad
authors.forename: Justin
authors.initials: J
authors.lastname: Allemano
authors.forename: Paolo
authors.initials: P
authors.lastname: Bossi
authors.forename: Marianne D
authors.initials: MD
authors.lastname: van de Wetering
authors.forename: Nikhil G
authors.initials: NG
authors.lastname: Rao
authors.forename: Carin
authors.initials: C
authors.lastname: Potting
authors.forename: Karis K
authors.initials: KK
authors.lastname: Cheng
authors.forename: Annette
authors.initials: A
authors.lastname: Freidank
authors.forename: Michael T
authors.initials: MT
authors.lastname: Brennan
authors.forename: Joanne
authors.initials: J
authors.lastname: Bowen
authors.forename: Kristopher
authors.initials: K
authors.lastname: Dennis
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Lalla
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D000777:Anesthetics / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000628:therapy; D006801:Humans; D017410:Practice Guidelines as Topic; D013280:Stomatitis / Q000188:drug therapy* / Q000517:prevention & control; D013392:Sucralfate / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D000777:Anesthetics; D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D013392:Sucralfate