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