Department of Dental Oncology, North East Cancer Center, Health Sciences North, Sudbury, Ontario, Canada,
Support Care Cancer. 2013 Nov;21(11):3191-207. doi: 10.1007/s00520-013-1871-y. Epub 2013 Jul 6.
The aim of this project was to develop clinical practice guidelines on the use of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the prevention and management of oral mucositis (OM) in cancer patients.
A systematic review of the available literature was conducted. The body of evidence for the use of each agent, in each setting, was assigned a level of evidence. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, or no guideline possible.
A recommendation was developed in favor of patient-controlled analgesia with morphine in hematopoietic stem cell transplant (HSCT) patients. Suggestions were developed in favor of transdermal fentanyl in standard dose chemotherapy and HSCT patients and morphine mouth rinse and doxepin rinse in head and neck radiation therapy (H&N RT) patients. Recommendations were developed against the use of topical antimicrobial agents for the prevention of mucositis. These included recommendations against the use of iseganan for mucositis prevention in HSCT and H&N RT and against the use of antimicrobial lozenges (polymyxin-tobramycin-amphotericin B lozenges/paste and bacitracin-clotrimazole-gentamicin lozenges) for mucositis prevention in H&N RT. Recommendations were developed against the use of the mucosal coating agent sucralfate for the prevention or treatment of chemotherapy-induced or radiation-induced OM. No guidelines were possible for any other agent due to insufficient and/or conflicting evidence.
Additional well-designed research is needed on prevention and management approaches for OM.
本项目旨在制定关于癌症患者口腔黏膜炎（OM）预防和管理中使用抗生素、黏膜保护剂、麻醉剂和镇痛药的临床实践指南。
对现有文献进行系统评价。根据每种药物在每种情况下的证据水平，对每种药物的使用进行证据等级评估。基于证据水平，可能做出以下三种指南决定之一：推荐、建议或无法制定指南。
在造血干细胞移植（HSCT）患者中，推荐使用吗啡自控镇痛。建议在标准剂量化疗和 HSCT 患者中使用经皮芬太尼，在头颈部放疗（H&N RT）患者中使用吗啡漱口液和多塞平漱口液。不建议使用局部抗菌药物预防黏膜炎。这包括不建议在 HSCT 和 H&N RT 中使用伊色甘钠预防黏膜炎，不建议在 H&N RT 中使用含多粘菌素-妥布霉素-两性霉素 B 的含片/糊剂和杆菌肽-克霉唑-庆大霉素含片预防黏膜炎。建议不要使用黏膜保护剂硫糖铝预防或治疗化疗或放疗引起的 OM。由于证据不足和/或相互矛盾，无法为任何其他药物制定指南。
需要更多设计良好的研究来探讨 OM 的预防和管理方法。
