Donnelly, J.P., Bellm, L.A., Epstien, J.B., Sonis, S.T., & Symonds, R.P. (2003). Antimicrobial therapy to prevent or treat oral mucositis. Lancet Infectious Diseases, 3, 405–412.

Database searched was Medline (1964–June 2002).

Keywords searched were anti-infective agents and mucositis or stomatitis. 

Articles were included in the review if they were written in English language and described human clinical trials.

Studies were excluded if they involved meta-analyses.

Study quality was scored on 0–5 scale (with 5 being the highest) depending on previously established criteria. Five studies scored 4, and eight scored 0. The mean score was 2.1, indicating overall lack of quality in published material.

Thirty-one eligible studies were identified. Twenty-eight of the studies used some kind of control, usually a placebo mouthwash or sterile water. Seventeen studies assessed chlorehexidine, and five studies investigated preparations containing polymyxin, tobramycin, and amphotericin; others included povidone-iodine; fluconazole; clindamycin; bacitracin, clotrimazole, and gentamicin; tetrachlorodecaoxide, ciprofloxacin, or ampicillin with clortrimazole; sucralfate versus sucralfate; ofloxacin, miconazole, tetracain, and guaiazulene; triacetin versus topical anesthetics or system icanalgesics; tetracycline, nystatin; hydrocortisone; and diphenhydramine versus placebo. The chlorexidine studies also included the following agents: benzydamine, nystatin, povidone-iodine, salt and soda, magic mouthwash, and clotrimazole.

The scale used was reported in 22 studies. Scales were World Health Organization (n = 4), Oral Assessment Guide (n = 7), 0–5 scale (n = 1), and 0–4 scale (n = 10).

The number of patients across studies ranged from 12–275.

• Of the 30 studies reporting a measurable outcome, 14 reported a benefit, 15 reported no benefit, and 1 reported an unfavorable outcome.
• Of the 17 studies involving chlorhexidine, one had an unfavorable outcome (i.e., increased oral mucositis and discomfort), 11 showed no benefit, and 7 groups showed some benefit.
• Four of the studies using other agents reported a benefit, four reported no benefit, and one reported only microbiologic data.

No clear pattern emerged regarding the benefit of antimicrobial use to manage oral mucositis.

Results draw attention to the multifaceted pathophysiology of oral mucositis, which presents a challenge for effective measures for prevention and treatment of mucositis.