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16-11-2011 | General practice | Article

Iseganan HCl oral rinse helps prevent chemotherapy-associated infection


Free abstract

MedWire News: Iseganan hydrochloride (HCl) solution is effective for preventing oral infections in patients receiving stomatotoxic chemotherapy, a randomized controlled trial indicates.

The treatment, given as a mouthwash, has "clear potential" for preventing aerobic, streptococcal, and yeast infections in these immunocompromised patients, say Sharon Elad (Hadassah School of Dental Medicine, Jerusalem, Israel) et al writing in the Journal of Oral Pathology & Medicine.

Cytotoxic chemotherapy induces changes in the oral microflora and may cause oral and systemic infections. In this trial, Elad's team tested the prophylactic efficacy of Iseganan HCl, a peptide with broad antimicrobial activity that has previously been shown effective in preventing oral mucositis.

A total of 225 myelosuppressed cancer patients were randomly assigned to use a mouthwash containing Iseganan HCl 9 mg/3 ml or placebo. The mouthwashes were administered as a "swish and swallow" solution and used six times daily for 21-28 days.

Treatment began on the first day of cytotoxic chemotherapy. At baseline, the total bacterial load was similar in the two groups, at 6.03 and 6.05 log10 colony-forming units (CFU) in the Iseganan HCl and placebo groups, respectively.

After just 1 day of treatment, however, total microbial load had fallen by 1.59 log10 CFU in the Iseganan HCl group but was virtually unchanged, falling by just 0.18 log10 CFU, in the placebo group.

The reduction in bacterial load in the Iseganan HCl group was sustained for the entire duration of treatment, and was driven largely by a fall in viridans streptococci and nonhemolytic streptococci. Yeast load also fell signficantly in the Iseganan HCl group, whereas the density of S. aureus and Gram-negative bacilli was low, and unchanged, in both groups.

In terms of susceptibility, the minimum inhibitory concentrations of Iseganan HCl for all isolates were similar and did not increase after either Iseganan HCl or placebo. The exception was coagulase-negative staphylococci, which increased by 1 log10 CFU in both treatment groups.

"This phenomenon is known to occur during treatment with high-dose chemotherapy; it is a short-term effect," write the authors.

Elad and colleagues say that Iseganan HCl has a low risk for promoting drug resistance and shows "durable efficacy" in reducing the microbial burden. The antifungal effect is "particularly promising," they add, while "it remains to be determined whether the antiseptic effect of Iseganan HCl will reduce bacteremia rates."

They conclude: "Because Iseganan HCl has immediate and long-lasting antimicrobial effects, studies of its efficacy in the prevention of oral infections and systemic infections originating from the oropharyngeal mucosal surfaces are warranted.

By Joanna Lyford

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