A pilot study evaluating the safety and microbiologic efficacy of an economically viable antimicrobial lozenge in patients with head and neck cancer receiving radiation therapy

El-Sayed, S.; Epstein, Joel B.; Minish, Erin; Burns, Patricia; Hay, John; Laukkanen, Ethan

doi:10.1002/hed.10044

Cited by 18 publications

(6 citation statements)

References 78 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A multicenter, randomized, double‐blind, placebo‐controlled clinical study of an oral antimicrobial lozenge (BCoG, bacitracin, 6 mg; clotrimazole, 10 mg; and gentamicin, 4 mg) to reduce acute radiation toxicity was carried out by the National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) 8. These antimicrobials are active against gram‐positive cocci, gram‐negative bacilli, and yeast microorganisms 10. The antimicrobial lozenge BCoG resulted in no significant benefit as measured by physician‐rated grade of mucositis.…”

mentioning

confidence: 99%

Quality of life, mucositis, and xerostomia from radiotherapy for head and neck cancers: A report from the NCIC CTG HN2 randomized trial of an antimicrobial lozenge to prevent mucositis

et al. 2005

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 99%

Quality of life, mucositis, and xerostomia from radiotherapy for head and neck cancers: A report from the NCIC CTG HN2 randomized trial of an antimicrobial lozenge to prevent mucositis

et al. 2005

View full text Add to dashboard Cite

show abstract

“…As a result, antibiotics (single or combinations) contained in mouthwashes, coatings or pastilles, or administered systemically, are often given prior to and during the course of therapy 2 ,. 5 , 23 , 24 , 94 , 95 Antimicrobial peptides (protegrins) have also been used, 96 , 97 as has acyclovir as an anti‐viral agent 98 . Whilst these treatments clearly lower micro‐organism load, particularly of Candida and Gram‐negative bacteria, their effect on oral mucositis remains equivocal.…”

mentioning

confidence: 99%

Oral and intestinal mucositis — causes and possible treatments

Duncan¹,

Grant²

2003

Aliment Pharmacol Ther

210

159

View full text Add to dashboard Cite

Summary Chemotherapy and radiotherapy, whilst highly effective in the treatment of neoplasia, can also cause damage to healthy tissue. In particular, the alimentary tract may be badly affected. Severe inflammation, lesioning and ulceration can occur. Patients may experience intense pain, nausea and gastro‐enteritis. They are also highly susceptible to infection. The disorder (mucositis) is a dose‐limiting toxicity of therapy and affects around 500 000 patients world‐wide annually. Oral and intestinal mucositis is multi‐factorial in nature. The disruption or loss of rapidly dividing epithelial progenitor cells is a trigger for the onset of the disorder. However, the actual dysfunction that manifests and its severity and duration are greatly influenced by changes in other cell populations, immune responses and the effects of oral/gut flora. This complexity has hampered the development of effective palliative or preventative measures. Recent studies have concentrated on the use of bioactive/growth factors, hormones or interleukins to modify epithelial metabolism and reduce the susceptibility of the tract to mucositis. Some of these treatments appear to have considerable potential and are at present under clinical evaluation. This overview deals with the cellular changes and host responses that may lead to the development of mucositis of the oral cavity and gastrointestinal tract, and the potential of existing and novel palliative measures to limit or prevent the disorder. Presently available treatments do not prevent mucositis, but can limit its severity if used in combination. Poor oral health and existing epithelial damage predispose patients to mucositis. The elimination of dental problems or the minimization of existing damage to the alimentary tract, prior to the commencement of therapy, lowers their susceptibility. Measures that reduce the flora of the tract, before therapy, can also be helpful. Increased production of free radicals and the induction of inflammation are early events in the onset of mucositis. Prophylactic administration of scavengers or anti‐inflammatories can partially counteract or limit some of these therapy‐mediated effects, as can the use of cryotherapy. The regular use of mouthwashes, mouth coatings, antibiotics and analgesics is essential, prior to and during loss and ablation of the epithelial layer. Granulocyte–macrophage colony‐stimulating factor/granulocyte colony‐stimulating factor or the use of laser light therapy may aid restitution and repair. Glutamine supplements may be beneficial in the repair/recovery phase.

show abstract

“…Of patients who were hospitalized, 20 were in the no prophylaxis cohort and 16 were in the AM prophylaxis cohort (55.6% vs. 39.0%, p ¼ 0.222). The median (IQR) length of hospital stay was 2 days (IQR, 2-4) in the no prophylaxis cohort and 9 days (IQR, [5][6][7][8][9][10][11][12][13][14][15][16][17] in the AM prophylaxis cohort. The patients in the AM prophylaxis cohort who were hospitalized had longer hospital stays than those in no prophylaxis cohort (p ¼ 0.007) ( Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…8 Additionally, antimicrobial (AM) lozenges (containing bacitracin, clotrimazole, and gentamicin) have been studied in the alleviation of radiation-induced mucositis in patients with H & N cancer, although endpoints did not include occurrence of infection. 9,10 A few small studies have evaluated the effectiveness of antifungal prophylaxis in H & N cancer patients, demonstrating the efficacy of fluconazole in reducing the severity of mucositis and preventing localized candida infections. [11][12][13][14] The use of prophylactic systemic AMs may potentially affect the incidence of local and/or systemic infections.…”

Section: Introductionmentioning

confidence: 99%

The role of antimicrobial prophylaxis in patients with head and neck cancer undergoing chemoradiation

Jaeger

Connelly

Jin

et al. 2019

J Oncol Pharm Pract

View full text Add to dashboard Cite

Background/objective National guidelines do not recommend the routine use of antimicrobial prophylaxis in patients with solid tumors, yet prophylactic agents are still sometimes prescribed for head and neck cancer patients. The purpose of this study is to determine the effect of prophylactic antimicrobials on the incidence of infection in patients undergoing chemoradiation for head and neck cancer. Methods Between 2013 and 2016, patients receiving chemoradiation for head and neck cancer at three outpatient oncology clinics were identified by retrospective review. Cohorts were based on administration or absence of prophylactic antimicrobials. The primary outcome of this study was incidence of infection. Secondary outcomes included incidence of hospitalization and length of hospital stay. Results Seventy-seven patients were analyzed, 47% (n = 36) were not prescribed antimicrobial prophylaxis and 53% (n = 41) were prescribed prophylaxis. Infection occurred in 31 patients in the no prophylaxis cohort and in 34 patients in the prophylaxis cohort (86.1% vs. 82.9%, p = 0.945). Twenty patients in the no prophylaxis cohort were hospitalized versus 16 patients in the prophylaxis cohort ( p = 0.222). The average length of hospital stay was 6 days in the no prophylaxis cohort and 10.6 days in the prophylaxis cohort ( p = 0.007). Conclusion The use of antimicrobial prophylaxis did not significantly impact the incidence of infection when compared to patients who were not prescribed prophylaxis. There was no difference in the incidence of hospitalization, however, the patients in the prescribed prophylactic group had longer length of hospital stay.

show abstract

A pilot study evaluating the safety and microbiologic efficacy of an economically viable antimicrobial lozenge in patients with head and neck cancer receiving radiation therapy

Abstract: This study demonstrated that the BCoG lozenge is tolerable and microbiologically efficacious, achieving elimination of Candida in all patients and reduction in gram-negative flora in most patients. A phase III study is underway to evaluate the clinical efficacy of this lozenge.

Cited by 18 publications

References 78 publications

Quality of life, mucositis, and xerostomia from radiotherapy for head and neck cancers: A report from the NCIC CTG HN2 randomized trial of an antimicrobial lozenge to prevent mucositis

Quality of life, mucositis, and xerostomia from radiotherapy for head and neck cancers: A report from the NCIC CTG HN2 randomized trial of an antimicrobial lozenge to prevent mucositis

Oral and intestinal mucositis — causes and possible treatments

The role of antimicrobial prophylaxis in patients with head and neck cancer undergoing chemoradiation

Contact Info

Product

Resources

About