Could you please guide me with the management of mucositis? I know it is a stepup approach and we usually start up with topical solutions such as Maalox Benadryl lidocaine. Then there is role of oral suctioning and oral hygiene. My patient is having gag reflex with all of these. Are there any other topical options we could consider? Patient is day 3 of stem cell infusion for testicular transplant and received carboplatin and etoposide as conditioning regimen. I was thinking of doing dexamethasone for 2 days, 5 mg IV twice daily. This would reduce inflammation. If mucositis becomes painful I was thinking of starting PCA pump.
Your approach is a good one. Mucositis is tricky in that there is not one solution that works for everyone. We typically start with an oral lidocaine-containing solution. If this is insufficient, other oral options are doxepin and dexamethasone. While these may be good for mild to moderate mucositis, for severe mucositis these options unfortunately often aren't enough to control the pain and so we often have to put those patients on a PCA until the mucositis improves. We also evaluate for possible infectious causes including candida and HSV and treat for those if identified.
