Cardona, A., Balouch, A., Mohammed, M.A., Sedghizadeh, P.P., & Enciso, R. (2017). Efficacy of chlorhexidine for the prevention and treatment of oral mucositis in cancer patients: A systematic review with meta-analyses. Journal of Oral Pathology and Medicine. Advance online publication.
DOI Link
Purpose
STUDY PURPOSE: To examine the effects of chlorhexidine on the incidence and severity of oral mucositis
TYPE OF STUDY: Meta-analysis and systematic review
Search Strategy
DATABASES USED: PubMed, Web of Science, Cochrane Collaboration through May 2015
INCLUSION CRITERIA: Randomized, controlled trial; the incidence or severity of mucositis was reported.
EXCLUSION CRITERIA: Gray literature
Literature Evaluated
TOTAL REFERENCES RETRIEVED: 143
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The Cochrane risk of bias assessment and the GRADE level of evidence criteria were used. Most studies were deemed to be at high risk of bias.
Sample Characteristics
- FINAL NUMBER STUDIES INCLUDED = 12, 9 studies in meta-analysis
- TOTAL PATIENTS INCLUDED IN REVIEW = 846
- SAMPLE RANGE ACROSS STUDIES: 16–222
- KEY SAMPLE CHARACTERISTICS: Most had head and neck cancer or a hematopoietic cell transplantation.
Phase of Care and Clinical Applications
PHASE OF CARE: Active antitumor treatment
Results
The incidence of mucositis was less with chlorhexidine. Across all studies, the relative risk (RR) ranged from 0.097–0.771 in favor of chlorhexidine (p = 0.05), with an overall RR of 0.899 (95% confidence interval [0.656, 1.232]). The findings for severity of mucositis were mixed.
Conclusions
Chlorhexidine was not associated with reduced severity of mucositis. There was a trend toward lower incidence of mucositis with chlorhexidine.
Limitations
- Mostly low quality/high risk of bias studies
- High heterogeneity
- Grade of mucositis not considered in analysis
Nursing Implications
There are overall mixed findings about the effects of chlorhexidine oral rinses on chemotherapy- and radiation therapy–induced mucositis, with limited evidence in each of these subgroups. It appears that chlorhexidine is not useful for the treatment of mucositis but may have some role in prevention.
Legacy ID
6487