colistin and Stomatitis

The aim of the study was to test the hypothesis that aerobic Gram-negative bacteria (AGNB) play a crucial role in the pathogenesis of radiation-induced mucositis; consequently, selective elimination of these bacteria from the oral flora should result in a reduction of the mucositis.. Head-and-neck cancer patients, when scheduled for treatment by external beam radiation therapy (EBRT), were randomized for prophylactic treatment with an oral paste containing either a placebo or a combination of the antibiotics polymyxin E, tobramycin, and amphotericin B (PTA group). Weekly, the objective and subjective mucositis scores and microbiologic counts of the oral flora were noted. The primary study endpoint was the mucositis grade after 3 weeks of EBRT.. Seventy-seven patients were evaluable. No statistically significant difference for the objective and subjective mucositis scores was observed between the two study arms (p = 0.33). The percentage of patients with positive cultures of AGNB was significantly reduced in the PTA group (p = 0.01). However, complete eradication of AGNB was not achieved.. Selective elimination of AGNB of the oral flora did not result in a reduction of radiation-induced mucositis and therefore does not support the hypothesis that these bacteria play a crucial role in the pathogenesis of mucositis.

Topics: Adult; Aged; Amphotericin B; Colistin; Double-Blind Method; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Head and Neck Neoplasms; Humans; Male; Middle Aged; Mouth Mucosa; Placebos; Radiation Injuries; Salivary Glands; Stomatitis; Tobramycin

The objective of this study was to determine whether a nonabsorbable antibiotic lozenge could alleviate radiation-induced oral mucositis.. Patients scheduled to receive radiation therapy to more than one-third of the oral cavity mucosa were selected for the study. After stratification, patients were randomized to receive either a nonabsorbable antibiotic lozenge or a placebo. Both groups were then evaluated for mucositis by health care providers and self-report instruments.. Fifty-four patients were randomized to receive the antibiotic lozenge and 58 to receive the placebo. There were no substantial differences or trends in mucositis scores between the two study arms as measured by the health care providers. However, the mean patient-reported mucositis score and the duration of patient-reported Grade 3-4 mucositis were both lower in the patients randomized to the antibiotic lozenge arm (P = 0.02 and 0.007, respectively).. This prospective, controlled trial provides evidence to suggest that a nonabsorbable antibiotic lozenge can decrease patient-reported radiation-induced oral mucositis to a modest degree. Nonetheless, this evidence does not appear to be compelling enough to recommend this treatment as part of standard practice.

Topics: Aged; Amphotericin B; Anti-Infective Agents, Local; Chlorhexidine; Colistin; Double-Blind Method; Drug Therapy, Combination; Female; Head and Neck Neoplasms; Humans; Intestinal Absorption; Male; Middle Aged; Mouth Mucosa; Radiation Injuries; Stomatitis; Tobramycin

The present investigation has examined the clinical benefits of tobramycin, polymyxin E and amphotericin therapy in the management of oral mucositis in children undergoing chemotherapy prior to bone marrow transplantation. Tobramycin, polymyxin E, and amphotericin reduced the degree of oral mucositis more than conventional therapy of diphenhydramine, Maalox, and local analgesic. While there was a statistically significant fall in the severity of the mucositis with tobramycin, polymyxin E and amphotericin, this was unlikely to be of practical benefit.

Topics: Adolescent; Aluminum Hydroxide; Amphotericin B; Antineoplastic Agents; Bone Marrow Transplantation; Child; Child, Preschool; Colistin; Diphenhydramine; Drug Combinations; Drug Therapy, Combination; Humans; Infant; Lidocaine; Magnesium Hydroxide; Mouth Mucosa; Stomatitis; Tobramycin; Transplantation Conditioning

Mucositis induced by irradiation is the reactive inflammatory-like process of the oropharyngeal mucous membranes following irradiation. Bacteria colonizing the oral tissues are thought to contribute to this inflammatory process. The eradication of Gram-negative bacilli (selective elimination of oral flora) in fifteen comparably irradiated head and neck cancer patients was found to be associated with a significant reduction in mucositis compared with two groups of 15 patients receiving either placebo or chlorhexidine rinsing. Criteria used were the extent of local mucositis signs (mucositis score), as well as generalized side-effects such as the need of nasogastric tube feedings following severe feeding problems. Mucositis signs were confined to erythema only in all selectively decontaminated patients. No pseudomembranes were observed and artificial feeding was completely prevented. These promising results need further confirmation in larger (multicenter) studies.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Candidiasis, Oral; Colistin; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Head and Neck Neoplasms; Humans; Male; Middle Aged; Mouth; Prospective Studies; Radiotherapy; Radiotherapy Dosage; Stomatitis; Tobramycin

Topics: Ampicillin; Bacterial Infections; Carbenicillin; Cephalothin; Child, Preschool; Chloramphenicol; Colistin; Erythromycin; Gentamicins; Humans; Lincomycin; Male; Microbial Sensitivity Tests; Moraxella; Neomycin; Oleandomycin; Oxacillin; Penicillins; Sepsis; Stomatitis; Streptomycin; Sulfamethoxazole; Sulfonamides; Tetracycline; Trimethoprim