{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T06:54:11Z","timestamp":1781765651034,"version":"3.54.5"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Support Care Cancer"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the use of treatments with antibacterial properties as prophylaxis prior to radiotherapy (RT), either alone or in combination with chemotherapy (CT), to prevent and reduce radiation-induced oral mucositis (RIOM) in patients with head and neck cancer (HNC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>A systematic search following PRISMA guidelines was conducted across PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant studies published in English through March 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Review methods<\/jats:title>\n                    <jats:p>Eligible studies assessed prophylactic antibacterial interventions aimed at preventing RIOM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 86 retrieved citations, 9 articles met inclusion criteria. Antibacterial agents assessed included polymyxin, tobramycin, amphotericin (PTA), povidone iodine, SAMITAL, and Nigella sativa (NS). Evidence supporting povidone iodine, PTA, and SAMITAL was inconclusive or failed to demonstrate statistically significant reductions in RIOM severity. Several studies reported discordant findings, with statistically significant improvements in patient-reported symptoms or quality-of-life measures despite nonsignificant clinician-assessed scores. NS demonstrated potential benefits in reducing RIOM incidence and severity compared with standard of care and other antibacterial agents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The systematic review highlights limited and inconsistent evidence supporting antibacterial prophylaxis for preventing and reducing RIOM severity in patients with HNC undergoing RT. Discrepancies between patient-reported outcomes and clinical-assessed grading suggest some treatments may provide symptomatic benefit not captured by traditional scoring systems. NS mouthwashes showed preliminary promise; however, evidence remains insufficient to establish superiority, and safety and regulatory concerns are persistent, particularly in immunosuppressed patients. Given the role of bacterial colonization and microbial dysbiosis in RIOM pathogenesis, larger, well-designed clinical trials with rigorous safety evaluations are warranted to investigate bacterial-directed preventive therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00520-026-10439-x","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T18:14:53Z","timestamp":1771870493000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Systematic review of prophylactic antibacterial agents for radiation-induced oral mucositis in head and neck cancer"],"prefix":"10.1007","volume":"34","author":[{"given":"Daniel S.","family":"Alicea","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahidul","family":"Islam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Schwartz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Ow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhur","family":"Garg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth N.","family":"McLellan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafi","family":"Kabarriti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"issue":"1","key":"10439_CR1","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1056\/NEJMra1715715","volume":"382","author":"LQM Chow","year":"2020","unstructured":"Chow LQM (2020) Head and neck cancer. N Engl J Med 382(1):60\u201372. https:\/\/doi.org\/10.1056\/NEJMra1715715","journal-title":"N Engl J Med"},{"issue":"19","key":"10439_CR2","doi-asserted-by":"publisher","first-page":"4423","DOI":"10.1002\/cncr.33100","volume":"126","author":"S Elad","year":"2020","unstructured":"Elad S, Cheng KKF, Lalla RV et al (2020) MASCC\/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 126(19):4423\u20134431. https:\/\/doi.org\/10.1002\/cncr.33100","journal-title":"Cancer"},{"issue":"4","key":"10439_CR3","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1016\/j.ijrobp.2007.01.053","volume":"68","author":"LS Elting","year":"2007","unstructured":"Elting LS, Cooksley CD, Chambers MS, Garden AS (2007) Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies. Int J Radiat Oncol Biol Phys 68(4):1110\u20131120. https:\/\/doi.org\/10.1016\/j.ijrobp.2007.01.053","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"1","key":"10439_CR4","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.ijrobp.2009.10.057","volume":"79","author":"G Sanguineti","year":"2011","unstructured":"Sanguineti G, Gunn GB, Parker BC, Endres EJ, Zeng J, Fiorino C (2011) Weekly dose-volume parameters of mucosa and constrictor muscles predict the use of percutaneous endoscopic gastrostomy during exclusive intensity-modulated radiotherapy for oropharyngeal cancer. Int J Radiat Oncol Biol Phys 79(1):52\u201359. https:\/\/doi.org\/10.1016\/j.ijrobp.2009.10.057","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"10","key":"10439_CR5","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1002\/cncr.28592","volume":"120","author":"RV Lalla","year":"2014","unstructured":"Lalla RV, Bowen J, Barasch A et al (2014) MASCC\/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 120(10):1453\u20131461. https:\/\/doi.org\/10.1002\/cncr.28592","journal-title":"Cancer"},{"issue":"1","key":"10439_CR6","doi-asserted-by":"publisher","DOI":"10.1186\/s13046-020-01715-7","volume":"39","author":"C Pulito","year":"2020","unstructured":"Pulito C, Cristaudo A, Porta C et al (2020) Oral mucositis: the hidden side of cancer therapy. J Exp Clin Cancer Res 39(1):210. https:\/\/doi.org\/10.1186\/s13046-020-01715-7","journal-title":"J Exp Clin Cancer Res"},{"issue":"1","key":"10439_CR7","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.cden.2007.10.002","volume":"52","author":"RV Lalla","year":"2008","unstructured":"Lalla RV, Sonis ST, Peterson DE (2008) Management of oral mucositis in patients who have cancer. Dent Clin North Am 52(1):61\u201377. https:\/\/doi.org\/10.1016\/j.cden.2007.10.002","journal-title":"Dent Clin North Am"},{"issue":"7","key":"10439_CR8","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1001\/jamaoncol.2023.0454","volume":"9","author":"Y Kost","year":"2023","unstructured":"Kost Y, Rzepecki AK, Deutsch A et al (2023) Association of Staphylococcus aureus colonization with severity of acute radiation dermatitis in patients with breast or head and neck cancer. JAMA Oncol 9(7):962\u2013965. https:\/\/doi.org\/10.1001\/jamaoncol.2023.0454","journal-title":"JAMA Oncol"},{"issue":"10","key":"10439_CR9","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1038\/nrmicro2873","volume":"10","author":"G Hajishengallis","year":"2012","unstructured":"Hajishengallis G, Darveau RP, Curtis MA (2012) The keystone-pathogen hypothesis. Nat Rev Microbiol 10(10):717\u2013725. https:\/\/doi.org\/10.1038\/nrmicro2873","journal-title":"Nat Rev Microbiol"},{"issue":"3","key":"10439_CR10","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.radonc.2013.05.021","volume":"107","author":"G Sanguineti","year":"2013","unstructured":"Sanguineti G, Rao N, Gunn B, Ricchetti F, Fiorino C (2013) Predictors of PEG dependence after IMRT\u00b1chemotherapy for oropharyngeal cancer. Radiother Oncol 107(3):300\u2013304. https:\/\/doi.org\/10.1016\/j.radonc.2013.05.021","journal-title":"Radiother Oncol"},{"issue":"3","key":"10439_CR11","doi-asserted-by":"publisher","first-page":"e378","DOI":"10.4317\/medoral.20338","volume":"20","author":"RM Diaz-Sanchez","year":"2015","unstructured":"Diaz-Sanchez RM, Pach\u00f3n-Ib\u00e1\u00f1ez J, Mar\u00edn-Conde F, Rodr\u00edguez-Caballero \u00c1, Gutierrez-Perez JL, Torres-Lagares D (2015) Double-blind, randomized pilot study of bioadhesive chlorhexidine gel in the prevention and treatment of mucositis induced by chemoradiotherapy of head and neck cancer. Med Oral Patol Oral Cir Bucal 20(3):e378\u2013e385. https:\/\/doi.org\/10.4317\/medoral.20338","journal-title":"Med Oral Patol Oral Cir Bucal"},{"key":"10439_CR12","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13235902","author":"P Gugnacki","year":"2021","unstructured":"Gugnacki P, Sierko E (2021) Is there an interplay between oral microbiome, head and neck carcinoma and radiation-induced oral mucositis? Cancers (Basel). https:\/\/doi.org\/10.3390\/cancers13235902","journal-title":"Cancers (Basel)"},{"issue":"8","key":"10439_CR13","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1177\/154405910608500802","volume":"85","author":"MA Stokman","year":"2006","unstructured":"Stokman MA, Spijkervet FK, Boezen HM, Schouten JP, Roodenburg JL, de Vries EG (2006) Preventive intervention possibilities in radiotherapy- and chemotherapy-induced oral mucositis: results of meta-analyses. J Dent Res 85(8):690\u2013700. https:\/\/doi.org\/10.1177\/154405910608500802","journal-title":"J Dent Res"},{"key":"10439_CR14","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https:\/\/doi.org\/10.1136\/bmj.n71","journal-title":"BMJ"},{"issue":"11","key":"10439_CR15","doi-asserted-by":"publisher","first-page":"2193","DOI":"10.1002\/(sici)1097-0142(19970601)79:11<2193::Aid-cncr18>3.0.Co;2-r","volume":"79","author":"SH Okuno","year":"1997","unstructured":"Okuno SH, Foote RL, Loprinzi CL et al (1997) A randomized trial of a nonabsorbable antibiotic lozenge given to alleviate radiation-induced Mucositis. Cancer 79(11):2193\u20132199. https:\/\/doi.org\/10.1002\/(sici)1097-0142(19970601)79:11%3c2193::Aid-cncr18%3e3.0.Co;2-r","journal-title":"Cancer"},{"issue":"2","key":"10439_CR16","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/s0360-3016(01)01444-4","volume":"50","author":"OB Wijers","year":"2001","unstructured":"Wijers OB, Levendag PC, Harms ERE et al (2001) Mucositis reduction by selective elimination of oral flora in irradiated cancers of the head and neck: a placebo-controlled double-blind randomized study. Int J Radiat Oncol Biol Phys 50(2):343\u2013352. https:\/\/doi.org\/10.1016\/s0360-3016(01)01444-4","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"7","key":"10439_CR17","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1038\/sj.bjc.6600824","volume":"88","author":"MA Stokman","year":"2003","unstructured":"Stokman MA, Spijkervet FKL, Burlage FR et al (2003) Oral mucositis and selective elimination of oral flora in head and neck cancer patients receiving radiotherapy: a double-blind randomised clinical trial. Br J Cancer 88(7):1012\u20131016. https:\/\/doi.org\/10.1038\/sj.bjc.6600824","journal-title":"Br J Cancer"},{"issue":"4","key":"10439_CR18","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.heliyon.2023.e15437","volume":"9","author":"D Kannarunimit","year":"2023","unstructured":"Kannarunimit D, Chotirut A, Prayongrat A et al (2023) A prospective randomized study comparing the efficacy between povidone-iodine gargling and benzydamine hydrochloride for mucositis prevention in head and neck cancer patients receiving concurrent chemoradiotherapy. Heliyon 9(4):8. https:\/\/doi.org\/10.1016\/j.heliyon.2023.e15437","journal-title":"Heliyon"},{"issue":"Suppl 2","key":"10439_CR19","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1159\/000246032","volume":"195","author":"R Rahn","year":"1997","unstructured":"Rahn R, Adamietz IA, Boettcher HD, Schaefer V, Reimer K, Fleischer W (1997) Povidone-iodine to prevent mucositis in patients during antineoplastic radiochemotherapy. Dermatology 195(Suppl 2):57\u201361. https:\/\/doi.org\/10.1159\/000246032","journal-title":"Dermatology"},{"issue":"7","key":"10439_CR20","doi-asserted-by":"publisher","first-page":"2445","DOI":"10.31557\/apjcp.2023.24.7.2445","volume":"24","author":"Y Namuangchan","year":"2023","unstructured":"Namuangchan Y, Chailertwanich O, Susinsamphan S et al (2023) Prophylaxis of oral mucositis with iodine solution during concurrent chemoradiation of head and neck cancer: preliminary results of a double-blind, randomized controlled trial. Asian Pac J Cancer Prev 24(7):2445\u20132454. https:\/\/doi.org\/10.31557\/apjcp.2023.24.7.2445","journal-title":"Asian Pac J Cancer Prev"},{"issue":"11","key":"10439_CR21","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.2217\/fon.13.165","volume":"9","author":"P Morazzoni","year":"2013","unstructured":"Morazzoni P, Petrangolini G, Bombardelli E, Ronchi M, Cabri W, Riva A (2013) SAMITAL\u00ae: a new botanical drug for the treatment of mucositis induced by oncological therapies. Future Oncol 9(11):1717\u20131725. https:\/\/doi.org\/10.2217\/fon.13.165","journal-title":"Future Oncol"},{"issue":"5","key":"10439_CR22","doi-asserted-by":"publisher","first-page":"58","DOI":"10.22159\/ijcpr.2019v11i5.35704","volume":"11","author":"HAM Ameen","year":"2019","unstructured":"Ameen HAM, Mohammed MO, Ahmed KM, Ali RHG, Saeed KA, Hussain SA (2019) Anti-inflammatory effect of Nigella Sativa oil on chemoradiation-induced oral mucositis in patients with head and neck cancers. Int J Curr Pharm Res 11(5):58\u201364. https:\/\/doi.org\/10.22159\/ijcpr.2019v11i5.35704","journal-title":"Int J Curr Pharm Res"},{"key":"10439_CR23","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12010381","author":"V Mehta","year":"2023","unstructured":"Mehta V, Sarode GS, Obulareddy VT et al (2023) Clinicopathologic profile, management and outcome of sinonasal ameloblastoma-a systematic review. J Clin Med. https:\/\/doi.org\/10.3390\/jcm12010381","journal-title":"J Clin Med"},{"issue":"3","key":"10439_CR24","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1007\/s00520-012-1586-5","volume":"21","author":"D Pawar","year":"2013","unstructured":"Pawar D, Neve RS, Kalgane S et al (2013) SAMITAL\u00ae improves chemo\/radiotherapy-induced oral mucositis in patients with head and neck cancer: results of a randomized, placebo-controlled, single-blind phase II study. Support Care Cancer 21(3):827\u2013834. https:\/\/doi.org\/10.1007\/s00520-012-1586-5","journal-title":"Support Care Cancer"},{"key":"10439_CR25","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14246192","author":"E Fasanaro","year":"2022","unstructured":"Fasanaro E, Del Bianco P, Groff E et al (2022) Role of SAMITAL in the prevention and treatment of chemo-radiotherapy-induced oral mucositis in head and neck carcinoma: a phase 2, randomized, double-blind, placebo-controlled clinical trial (ROSAM). Cancers. https:\/\/doi.org\/10.3390\/cancers14246192","journal-title":"Cancers"},{"issue":"7","key":"10439_CR26","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1001\/jamaoncol.2023.0444","volume":"9","author":"Y Kost","year":"2023","unstructured":"Kost Y, Deutsch A, Mieczkowska K et al (2023) Bacterial decolonization for prevention of radiation dermatitis: a randomized clinical trial. JAMA Oncol 9(7):940\u2013945. https:\/\/doi.org\/10.1001\/jamaoncol.2023.0444","journal-title":"JAMA Oncol"},{"issue":"10","key":"10439_CR27","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1001\/jamaoncol.2025.2361","volume":"11","author":"Z Liao","year":"2025","unstructured":"Liao Z, Xiong X, Zhao L, Zhang Z, Guan C, Zhang L, Zhong F, Rao J, Wang X, Xiao Y, Gong X, Huang SH, Li J, Lu T (2025) Bacterial decolonization with mupirocin ointment for acute radiation oral mucositis prevention: a phase 3 randomized clinical trial. JAMA Oncol 11(10):1141\u20131149. https:\/\/doi.org\/10.1001\/jamaoncol.2025.2361","journal-title":"JAMA Oncol"}],"updated-by":[{"DOI":"10.1007\/s00520-026-10806-8","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000}}],"container-title":["Supportive Care in Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-026-10439-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00520-026-10439-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-026-10439-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T06:31:12Z","timestamp":1781764272000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00520-026-10439-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,23]]},"references-count":27,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10439"],"URL":"https:\/\/doi.org\/10.1007\/s00520-026-10439-x","relation":{},"ISSN":["0941-4355","1433-7339"],"issn-type":[{"value":"0941-4355","type":"print"},{"value":"1433-7339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,23]]},"assertion":[{"value":"28 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2026","order":5,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":6,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1007\/s00520-026-10806-8","URL":"https:\/\/doi.org\/10.1007\/s00520-026-10806-8","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"234"}}