Improving malodour management in advanced cancer: a 10-year retrospective study of topical, oral and maintenance metronidazole
| Autor: | Shakila Murali, Thangarathi Celine, Thotampuri Shanthi Prasoona, Renitha Miriam Cherian, Ramu Kandasamy, David Mathew, Jenifer Jeba, Reena George |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Palliative care Medicine (miscellaneous) Administration Oral Uterine Cervical Neoplasms Administration Cutaneous 03 medical and health sciences Necrosis 0302 clinical medicine Anti-Infective Agents 030202 anesthesiology Internal medicine Metronidazole medicine Humans Head and neck Retrospective Studies Cervical cancer Oncology (nursing) business.industry Maggot Palliative Care Retrospective cohort study General Medicine medicine.disease Advanced cancer Surgery Medical–Surgical Nursing Treatment Outcome Head and Neck Neoplasms 030220 oncology & carcinogenesis Odorants Case note Female business medicine.drug |
| Zdroj: | BMJ supportivepalliative care. 7(3) |
| ISSN: | 2045-4368 |
| Popis: | Objectives To explore the relative effectiveness of topical or oral metronidazole used for malodour in necrotic cancers and to propose a protocol for metronidazole usage in managing malodour. Methods A retrospective case note review of the management of malodour over 10 years comparing outcomes with topical, intermittent and maintenance oral metronidazole. Results Among 179 patients treated for malodour, the commonest primaries were cervical (45%), and head and neck cancers (40%). Outcomes were poor during the period when only topical or intermittent oral metronidazole was used. Topical use gradually decreased (97% vs 55%) and the proportion of patients receiving maintenance oral metronidazole increased (0% in 2003–2004 vs 93% in 2011). Concurrently, there was reduction in documented malodour (12.5% of visits per patient in 2003–2004 vs 1.5% in 2011, p Conclusions Our data support formulary guidelines recommending maintenance metronidazole for recurrent malodour. Dimethyl trisulfide, a product of anaerobic necrosis causes malodour and can attract maggot-producing flies to decaying tissues. Therefore, to reduce anaerobic malodour in vulnerable settings, we propose a ladder for metronidazole titration. High-risk patients should start with 400 mg thrice daily ×7 days and continue 200 mg once daily. The SNIFFF severity (Smell-Nil, Faint, Foul or Forbidding) can guide follow-up dosage: 200 mg once daily to continue for nil or faint smell; breakthrough courses of 400 mg thrice daily ×1 week for foul smell and 2 weeks for forbidding smell, followed by 200 mg once daily. The effectiveness and limitations of maintenance metronidazole and the SNIFFF ladder should be prospectively evaluated. |
| Databáze: | OpenAIRE |
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