povidone-iodine and Stomatitis

Radiation-induced oral mucositis is an acute morbidity seen in patients undergoing treatment for head and neck cancers. In this study, we evaluated the efficacy of turmeric in preventing radiation-induced mucositis.. This was a single-blinded, randomized, controlled clinical trial and was conducted with head and neck cancer patients requiring 70 Gy of radiation or chemoradiotherapy (daily radiotherapy plus carboplatin once a week). Eligible patients (n = 80) were randomly assigned to receive either turmeric gargle (n = 40) or povidone-iodine ([n = 40] active comparator condition) during chemo/radiotherapy during the period of treatment. Oral mucositis was assessed using the RTOG (Radiation Therapy Oncology Group) grading system before the start, during, and at the end of the treatment by an investigator unaware of the treatment. The primary endpoint of this study was the incidence of mucositis every week during the 7-week period. The secondary endpoint was the effect of turmeric gargle on the incidence of treatment breaks, loss of scheduled treatment days, and decrease in body weight at the end of the treatment.. This study clearly suggests that when compared with the cohorts using povidone-iodine gargle, the group using turmeric as a mouthwash had delayed and reduced the levels of radiation-induced oral mucositis and was statistically significant at all time points (P< 0.001 toP< 0.0001). Additionally, the cohorts using turmeric had decreased intolerable mucositis (P< 0.001) and lesser incidence of treatment breaks in the first half of the treatment schedule before 4 weeks (P< 0.01) and reduced change in body weight (P< 0.001).. Gargling with turmeric by head and neck cancer patients undergoing radiation therapy provided significant benefit by delaying and reducing the severity of mucositis. Turmeric is readily available, relatively inexpensive, and highly accepted making it useful in cancer treatment.

Topics: Adult; Aged; Anti-Infective Agents, Local; Carboplatin; Chemoradiotherapy; Curcuma; Female; Head and Neck Neoplasms; Humans; Incidence; Male; Middle Aged; Mouthwashes; Povidone-Iodine; Radiation Injuries; Single-Blind Method; Stomatitis; Time Factors

We evaluated the effects of special oral care using a toothbrush with combined irrigation and suctioning functions, along with povidone-iodine to treat oral bacteria and mucositis, in esophageal cancer patients undergoing chemoradiotherapy. In the special care group, oral hygiene was performed 3 days a week after dinner. Bacteria in saliva and plague samples were measured at various sampling points after chemoradiotherapy. The incidence of mucositis was significantly reduced in the special care group in comparison with the control group. Total streptococci were significantly decreased in the opportunistic pathogens-positive and lower-level mutans streptococci control group during chemoradiotherapy, but they were not reduced in the opportunistic pathogens-negative and higher-level mutans streptococci control groups or in the special care group. Our results showed that a special oral care regimen enabled the total population of streptococci microflora to remain stable, was negatively correlated with opportunistic pathogens and positively correlated with mutans streptococci infection, and prevented the development of mucositis.

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Combined Modality Therapy; Esophageal Neoplasms; Female; Humans; Male; Middle Aged; Oral Hygiene; Povidone-Iodine; Stomatitis; Streptococcal Infections; Streptococcus

Antimicrobial solutions are widely used in the nursing care of chemotherapy induced oral mucositis (OM). There is little evidence, however, supporting their use for reducing mucosal damage. In our study, 132 patients were randomized to use normal saline (n=65) or povidone-iodine diluted 1:100 (n=67) mouthwashes for OM prophylaxis and treatment after high-dose chemotherapy comprising BEAM or HD-L-PAM followed by autologous peripheral stem cell transplantation. The study groups were well balanced in respect of age, sex, chemotherapy and the number of CD34+ cells in the graft. No significant difference was found between the groups in respect of OM characteristics, fever of unknown origin (FUO) and other infections. The antimicrobial solution was less tolerable for patients. OM occurred significantly more often in females than in males (86% vs 60%, P=0.0016) and was worse and of longer duration. The mechanical effect of mouthwashes might have a certain importance in FUO prevention. When indicating oral rinses, the patient's individual preference and tolerance of solutions offered should be considered.

Topics: Adult; Aged; Anti-Infective Agents, Local; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Cytarabine; Etoposide; Female; Humans; Male; Melphalan; Middle Aged; Mouth Mucosa; Mouthwashes; Peripheral Blood Stem Cell Transplantation; Povidone-Iodine; Sex Factors; Sodium Chloride; Stomatitis; Transplantation, Autologous

We have conducted a prospective controlled randomised clinical study testing for the efficacy of topical GM-CSF (molgramostim), as compared to the combined topical use of an antiseptic agent (povidone-iodine) and amphotericin B (AA) in patients with chemotherapy-induced mucositis World Health Organization (WHO) grades I-III. 31 patients (17 females, 14 males) developing oral mucositis following the administration of 5-fluorouracil (5-FU)-based chemotherapy were entered into the present trial. 15 patients were randomised to receive GM-CSF mouthwashes, whereas 16 patients were randomised into the control arm to receive AA. Reported history (P=0.6109) and grading of oral mucositis (2.1+/-0.7, respectively; P=0.9867) were balanced and equally distributed between the two groups. The mean size of lesions of oral mucositis was 1.5+/-0.6 cm (range: 0.7-2.5 cm) in the GM-CSF group and 1.2+/-0.5 cm (range: 0.5-2.5 cm) in the AA group (P=0.08), respectively. The mean number of oral mucositis lesions was 1.9+/-1.1 (range: 1-4) in the GM-CSF group and 2.1+/-1.2 (range: 1-4) in the AA group (P=0.63), respectively. None of the patients had previously received colony stimulating factors either topically or systemically. Treatment for oral mucositis was initiated on day 2.7+/-1.2 (range: day 1-8) after onset of symptoms in the GM-CSF group and on day 1.8+/-1.4 (range: day 1-3; P=0.11) in the AA group. The topical application of GM-CSF resulted in a significantly shorter duration and quicker resolution of oral mucositis, as compared to AA including both, pretreatment plus treatment periods (5.3+/-2.5 versus 8.1+/-1.5 days; P=0.0008) as well as the necessary duration of treatment needed until complete remission of lesions (2.8+/-0.7 versus 6.3+/-1.1 days; P<0.0001). A systemic effect of topical GM-CSF upon the number of peripheral blood leukocytes or granulocytes was excluded. We conclude that the topical application of GM-CSF by mouthwash significantly abbreviated the duration and relieved patients from symptoms of chemotherapy-induced mucositis and was superior to the topical application of AA.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antimetabolites, Antineoplastic; Drug Administration Schedule; Female; Fluorouracil; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Leukocyte Count; Male; Middle Aged; Mouth Mucosa; Mouthwashes; Povidone-Iodine; Prospective Studies; Protective Agents; Recombinant Proteins; Severity of Illness Index; Single-Blind Method; Stomatitis; Time Factors; Treatment Outcome

Oral mucositis is a frequent complication of radiochemotherapy. The origin of radiation-induced mucosa lesions is of iatrogenic nature although further development of mucositis is essentially influenced by infection. It can be assumed that disinfection measures should decrease the severity of mucositis induced by radiochemotherapy. Therefore, in a prospective randomised study the efficacy of prophylactic oral rinsing with a disinfection agent was investigated.. An open, randomised, prospective comparative trial was conducted with 40 patients undergoing radiochemotherapy of head and neck region due to malignant disease. The treatment scheme consisted of irradiation to tumor region and adjacent lymph nodes with a total dose of 71.3 Gy and simultaneous chemotherapy with carboplatin (60 mg/m2) on days 1 to 5 and 29 to 34. In all patients, a prophylaxis of mucositis with nystatine, rutosides, panthenol and immunoglobulin was undertaken. In addition, 20 patients rinsed oral cavity 4 times daily with povidone-iodine-solution, the comparative group rinsed with sterile water. Clinical examination of the oral mucosa was performed weekly. Onset, grading and duration of mucositis were used as main variables.. Clinically manifested oral mucositis was observed in 14 patients of the iodine group (mean grading: 1.0) and all 20 patients of the control group (mean grading: 3.0). Total duration (mean) of clinically observed mucositis was 2.75 weeks in treatment patients and 9.25 in control patients. Median AUC (area under curve for grade vs duration) was 2.5 in iodine rinsing patients and 15.75 in control patients. All differences found between the 2 groups were statistically significant. Increased iodine incorporation was not observed. A pathological increase of thyroid hormone levels in the iodine group was not found.. The gained results indicate that incidence, severity and duration of radiochemotherapy-induced mucositis can be significantly reduced by oral rinsing with povidone-iodine performed additionally to the standard prophylaxis scheme.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antifungal Agents; Antineoplastic Agents; Carboplatin; Combined Modality Therapy; Female; Head and Neck Neoplasms; Humans; Immunization, Passive; Male; Middle Aged; Mouthwashes; Nystatin; Ointments; Pantothenic Acid; Povidone-Iodine; Prospective Studies; Radiotherapy; Radiotherapy Dosage; Rutin; Stomatitis; Time Factors; Vasodilator Agents

Oral mucositis is a frequent complication of radiochemotherapy. The origin of radiation-induced mucosal lesions is iatrogenic in nature, although further development of mucositis is essentially influenced by infection. It can be assumed that disinfection measures should decrease the severity of mucositis induced by radiochemotherapy. Therefore, in a prospective randomised study the efficacy of prophylactic oral rinsing with a disinfection agent was investigated. A randomised, prospective comparative trial was conducted with 40 patients undergoing radiochemotherapy of the head and neck region because of malignant disease. The treatment scheme consisted of irradiation to the tumour region and adjacent lymph nodes, with a total dose of 71.3 Gy, and simultaneous chemotherapy with carboplatin (60 mg/m2) on days 1-5 and 29-34. In all patients mucositis prophylaxis with nystatin, rutosides, panthenol and immunoglobulin was undertaken. In addition, 20 patients rinsed the oral cavity 4 times daily with povidone-iodine solution, while the group for comparison rinsed with sterile water. Clinical examination of the oral mucosa was performed weekly. Onset, grading and duration of mucositis were used as the main variables. Clinically manifest oral mucositis was observed in 14 patients in the iodine group (mean grading: 1.0) and in all 20 patients in the control group (mean grading: 3.0). The total duration (mean) of clinically observed mucositis was 2.75 weeks in treatment patients and 9.25 weeks in control patients. Median AUC (area under curve for grade vs duration) was 2.5 in the iodine rinsing patients and 15.75 in control patients. All differences found between the two groups were statistically significant. Increased iodine incorporation was not observed. A pathologic rise in thyroid hormone levels was not found in the iodine group. The results obtained indicate that incidence, severity and duration of radiochemotherapy-induced mucositis can be significantly reduced by oral rinsing with povidone-iodine in addition to the standard prophylaxis scheme. It can be concluded that rinsing with povidone-iodine is an easy, cheap and safe prophylactic method and can be recommended as a supportive treatment during antineoplastic treatment of the head and neck region.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Antineoplastic Agents; Chi-Square Distribution; Combined Modality Therapy; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Mouth Mucosa; Povidone-Iodine; Radiotherapy; Reference Values; Stomatitis; Treatment Outcome

In an open study, the efficacy of povidone-iodine in the prophylaxis of mucositis during antineoplastic radiochemotherapy was determined. 40 patients were randomly assigned to a treatment or control group (each 20 patients). All patients received standard prophylaxis of mucositis with nystatin, dexpanthenol, rutoside and immunoglobulin. In addition, the patients of the treatment group performed 4 times daily rinsing with povidone-iodine, the control patients with sterile water. Clinical examination of the oral mucosa was performed weekly during the radiation period and up to 6 weeks after the end of therapy. Oral mucositis was observed in 14 patients of the treatment group (mean grading: 1.0) and in all 20 patients of the control group (mean grading: 3.0). The mean onset of mucositis was after 2.25 weeks in treatment patients and 1.5 weeks in control patients. The mean total duration of mucositis was 2.75 weeks in treatment patients and 9.25 weeks in control patients. The mean AUC values were 2.5 in treatment patients and 15.75 in control patients. All findings were statistically significantly different between the two groups. It is concluded that rinsing with povidone-iodine reduces the incidence, severity and duration of oral mucositis during antineoplastic radiochemotherapy.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Area Under Curve; Chemoprevention; Combined Modality Therapy; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Immunization, Passive; Incidence; Iodophors; Male; Middle Aged; Mouthwashes; Nystatin; Pantothenic Acid; Povidone-Iodine; Radiotherapy; Rutin; Stomatitis; Time Factors; Vasodilator Agents

Wound healing represents a dynamic process of increasing scientific interest, especially with the detection of the different growth factors. Economic aspects are also of importance in the investigation of substances used for wound healing. In Germany 25% of all patients (ca. 1 million) with severe chronic venous insufficiency have crural ulcers. The influence of bacterial infection of crural ulcers is controversial. There is no doubt that the quantity of bacteria is of importance. Local antibiotic treatment is difficult, as most of the substances used are known to inhibit wound healing. In vivo and in vitro investigations showed, that chiniofon-containing antiseptic has a bacteriostatic function. Additionally it was shown, using cultures of fibroblasts, that chiniofon-containing antiseptic does not inhibit the growth of fibroblasts, whereas PVP-iodine solution, a widely used antiseptic, clearly reduces the growth of fibroblasts. The good clinical results in the treatment of acute and chronic radiation damage indicate that chiniofon-containing antiseptic may have antiflammatory activity.

Topics: Administration, Topical; Adult; Aged; Animals; Breast Neoplasms; Cell Division; DNA Replication; Dose-Response Relationship, Drug; Female; Humans; In Vitro Techniques; L Cells; Male; Mice; Microbial Sensitivity Tests; Middle Aged; Mouth Mucosa; Otorhinolaryngologic Neoplasms; Povidone-Iodine; Radiodermatitis; Skin; Stomatitis; Superinfection; Varicose Ulcer; Wound Healing