How do you approach patients with severe mucositis receiving chemo-radiation for head and neck cancer with regards to empiric antifungal or antiviral treatment?

Severe mucositis remains a problem for patients receiving chemoradiotherapy for locally advanced head and neck cancers. While neutropenia can occur in some patients, it is not as frequently seen when compared to those who undergo bone marrow transplants, meaning that our patients do not commonly develop viremia. Hence, the use of anti-viral agents as prophylaxis for HSV is not warranted. Thrush, on the other hand, is more common; however, we do not have data supporting the use of prophylactic an...

We advise oral care that includes salt and soda rinse every 4 to 6 hours, or more often as needed. Use one of the rinses listed below:

• One quart (4 cups) of water mixed with 1 teaspoon of salt and 1 teaspoon of baking soda.
• This has some bactericidal and fungicidal effects, but beyond this, I do not prescribe meds proactively for treating thrush and antibacterials.

I don't empirically treat with either of these, but treat infections should they arise, but do have everyone swish and spit a salt and soda mix.

When someone does get thrush, I prefer to treat with Fluconazole orally rather than with a topical antifungal like nystatin. It works in everyone the first time, and patient satisfaction is much higher.

Although it wasn't really asked about, in H&N patients with bad disease, I also pay attention to smell, and if they start smelling necrotic, empirically...