Improving malodour management in advanced cancer: a 10-year retrospective study of topical, oral and maintenance metronidazole.
BMJ Support Palliat Care
; 7(3): 286-291, 2017 Sep.
Article
em En
| MEDLINE
| ID: mdl-28174164
ABSTRACT
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 10â 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<0.01).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 400â mg thrice daily ×7â days and continue 200â mg once daily. The SNIFFF severity (Smell-Nil, Faint, Foul or Forbidding) can guide follow-up dosage 200â mg once daily to continue for nil or faint smell; breakthrough courses of 400â mg thrice daily ×1â week for foul smell and 2â 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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias do Colo do Útero
/
Neoplasias de Cabeça e Pescoço
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Metronidazol
/
Anti-Infecciosos
/
Odorantes
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
Idioma:
En
Revista:
BMJ Support Palliat Care
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Índia