Pitten, F.A., Kiefer, T., Buth, C., Doelken, G., & Kramer, A. (2003). Do cancer patients with chemotherapy-induced leukopenia benefit from an antiseptic chlorhexidine-based oral rinse? A double-blind, block-randomized, controlled study. Journal of Hospital Infection, 53(4), 283–291.

To assess the benefit of antiseptic mouthwash in patients with leukopenia because of a decrease in micro-organisms

• Patients were randomized to chlorhexidine or fluoride rinse (control group).
• Patients rinsed three times per day for 30 seconds from the start of chemotherapy to the end of leukopenia.
• Pre-rinsing during and after leukopenia, aerobic and anaerobic bacteria in oral cavity were counted.
• Patients were assessed for oral mucositis.
• Patients did not brush teeth when leukopenic.

• The sample consisted of 47 patients.
• Patients had solid tumor and hematologic diagnoses.

• Bacterial swabs were taken pre-, during and post-treatment.
• Clinician assessment and mucositis scores were taken.
• C-reactive protein was measured.

• In the chlorhexidine group, a significant decrease in aerobic (p = 0.042) and anaerobic (p = 0.008) bacterial flora were identified.
• In the control group, the numbers of bacteria were unchanged (p > 0.05).
• More patients in the chlorhexidine group had severe mucositis and inflammation, but this was not significant.

Chlorhexidine did not provide a clinical benefit against mucositis.

• The study had a small sample.
• The oral assessment was unclear.