Effect of selective elimination of the oral flora on mucositis in irradiated head and neck cancer patients

Authors

  • Fred K. L. Spijkervet DDS, PhD,

    Corresponding author
    1. Departments of Oral and Maxillofacial Surgery, University of Croningen and University Hospital, Croningen, the Netherlands
    • Department of Oral and Maxillofacial Surgery. University Hospital, A. Deusinglaan 1, 9713 AV. Groningen. The Netherlands
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  • Hendrik K. F. Van Saene MD, PhD,

    1. Medical Statistics, University of Croningen and University Hospital, Croningen, the Netherlands; and the Department of Medical Microbiology, University of liverpool, liverpool, England
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  • Joris J. M. Van Saene PharmD, PhD,

    1. Departments of Pharmaceutical Technology and Dispensing, University of Croningen and University Hospital, Croningen, the Netherlands
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  • Arend K. Panders DDS, PHD,

    1. Departments of Oral and Maxillofacial Surgery, University of Croningen and University Hospital, Croningen, the Netherlands
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  • Albert Vermey MD, PhD, FACS,

    1. Departments of Surgery, Division of Oncology, University of Croningen and University Hospital, Croningen, the Netherlands
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  • Dinesz M. Mehta MD,

    1. Departments of Radiotherapy, University of Croningen and University Hospital, Croningen, the Netherlands
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  • Vasek Fidler PhD

    1. Departments of Oral and Maxillofacial Surgery, University of Croningen and University Hospital, Croningen, the Netherlands
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Abstract

Recently it has been reported that chlorhexidine 0.1 % rinsing was not successful in eradication of gram-negative bacilli in patients who have head and neck cancer. These bacilli could play a role in irradiation mucositis. This study reports the effect of lozenges containing 2 mg polymyxin E, 1.8 mg tobramycin, and 10 mg amphotericin B qid on the oropharyngeal flora in 15 irradiated head and neck cancer patients. The results were compared with those of a previous study in two groups of 15 patients comparing chlorhexidine rinsing with placebo. In all patients using lozenges, eradication of gram-negative bacilli and yeasts was achieved within 3 weeks. A significant increase of enterococci was found. Mucositis was significantly reduced compared with the previous two groups. All patients showed erythema only, whereas 80% of both the placebo and chlorhexidine rinsing patients suffered from severe mucositis, with signs of pseudomembranes developing from the third week of conventional irradiation protocol. The effect of selective elimination of gram-negative bacilli from the oropharynx and the prevention of severe mucositis may be explained by the eradication of these bacteria and/or neutralization of salivary endotoxin, released by gram-negative bacilli, mediating the inflammatory processes.

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