Prophylaxis with povidone-iodine against induction of oral mucositis by radiochemotherapy

Abstract

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.

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients

“…An unblinded RCT of 40 H&N cancer patients undergoing chemoradiation reported that rinsing the mouth with povidone-iodine resulted in reduced incidence of OM as compared to rinsing with sterile water (n=20 in each group) [1,68]. Another study, in patients receiving chemoradiation for esophageal cancer, evaluated an oral hygiene regimen consisting of povidone-iodine mouth rinse in combination with toothbrushing with a special brush, irrigation, suctioning, and cleaning of oral mucosal surfaces, all performed by a dentist.…”

Oral Mucositis Complicating Chemotherapy and/or Radiotherapy: Options for Prevention and Treatment

“…Similarly, dexpanthenol, 161,162,165,166 a granulation-promoting agent; caustic compounds such as aluminium hydroxide, and milk of magnesia; 88 and mouth-coating agents including kaolinpectin are part of many multiagent mouthrinses, although their efficacy has not yet been demonstrated in single-agent trials.…”

Failure of anti-infective mouth rinses and concomitant antibiotic prophylaxis to decrease oral mucosal colonization in autologous stem cell transplantation

“…Therefore, many prophylactic regimens aimed at the prevention of oral infection by using different anti-infective mouth rinses. [19][20][21][22][23][24][25] The anti-infectives used in our study, that is, PVP, chlorhexidine, polyenes, and sage tea, have been examined in previous clinical trials. Some of these trials examined their effectiveness in preventing or alleviating mucositis.…”

“…Mouth rinsing with povidone-iodine successfully prevented oral mucositis in patients receiving combined radiochemotherapy for the treatment of head and neck cancer. 25,33 The present study aimed at the changes of the oral microflora following prophylactic treatment with a combination of different anti-infectives. We found that even through the frequent use of several mouth rinses, the longitudinal impact on bacterial and fungal colonisation was negligible.…”