Antimicrobial prophylaxis
The administration of antibiotics for prophylaxis is a common practice
in the management of oral mucositis. The premise for the use of
antibiotics is mainly to mitigate or prevent infection or microbial
colonization. Microbial colonization is likely to intensify the
inflammatory process as well as exacerbating and perhaps even causing
extensive ulceration to the already injured mucosa. To date, evidence is
still conflicting concerning the use of prophylactic antibiotics. Most
centers still administer antibiotics to all patients who present with
mucosal injury despite the lack of evidence. 4075 We recognized two studies that used gentamicin and
metronidazole for antibiotic prophylaxis. Both treatment group in the
clinical trials used gentamicin in a compounded multi-agent mouth wash.
The outcomes for the two trials reported positive results in terms of
pain management, infection control and reduced severity of oral
mucositis. 16 21One clinical trial
highlighted the need for mucosal cultures for targeted antimicrobial
treatment for patients who present with oral ulcerations after paraquat
ingestMontmorillonite and smecta
Montmorillonite and smecta is a natural clay mineral belonging to the
smectite group. Smectites are natural clay minerals that have several
clinical applications in medicine (absorbents, antacids and
antidiarrheal). The compounds are absorbents (enterosorbents), their
high absorption capacity aid in the absorption of toxins within the
gastrointestinal tract. The contact effect of medical clay on the GI
mucosa creates a protective layer on the mucosa, therefore also serving
a protective purpose. Due to their muco-adhesive nature, smectites
create a barrier and prevents further damage on the mucosa. Smectite
compounds also have antibacterial and antiviral properties in that they
bind to the pathogens and allow enhanced elimination of the microbes and
therefore reducing the chances of possible secondary infections.
Smectites have not only been found to be useful in gastrointestinal
mucosa, but compounded mouthwashes containing these compounds also play
an important protective role to the oral mucosa. 4142 The first clinical trial used montmorillonite as a
base for a compounded paste. 5 grams of montmorillonite was used in
conjunction with tea oil and Vit C for the formulation. In the treatment
group the paste was used to adequately cover the oral mucosa and ulcer
surfaces three times a day for duration of five days. The paste gave a
positive outcome in terms of pain reduction and improved healing time
for the patients. 25The second trial used smecta
powder 2-3 times a day to adequately cover the oral mucosa in
conjunction with other interventions. The trial also had positive
results in the management of oral mucositis.