Systematic review of prophylactic antibacterial agents for radiation-induced oral mucositis in head and neck cancer

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.