***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Painful oral mucositis is a common complication after  bone marrow transplantation ( BMT ) . Glutamine is a nutrient for rapidly dividing cells and the major energy source for intestinal epithelium . This study tested whether an oral glutamine preparation could decrease the severity of oral mucositis in patients undergoing BMT . Glutamine or a placebo ( glycine ) were administered from admission until day + 28 in 193 BMT patients in a r and omized , double-blind , placebo-controlled study at a dose of 1.0 g amino acid/m2/dose swish and swallow four times a day . In  autologous BMT patients ( n = 87 ) glutamine was associated with significantly less mouth pain by self report and by opiate use ( 5.0 ± 6.2 days of morphine for glutamine vs 10.3 ± 9.8 days for placebo ; P = 0.005 ) . Matched sibling BMT patients had no effect by self report and an increased duration of opiate use ( 23.2 ± 5.7 days for glutamine vs 16.3 ± 8.3 days for placebo ) ( P = 0.002 ) . However , day 28 survival of allogeneic patients was improved by glutamine . No significant differences in TPN use , rate of relapse or progression of malignancy , parenteral antibiotic use , acute or chronic GVHD , or days of hospitalization were observed in either autologous or allogeneic recipients . No toxicity of glutamine was observed . We conclude that oral glutamine can decrease the severity and duration of oropharyngeal mucositis in autologous BMT patients but not in allogeneic BMT patients , possibly due to interaction with methotrexate The impact of prophylaxis with 400 mg/day fluconazole on fungal colonization at different body sites was assessed in a r and omized , double-blind , placebo controlled study among patients with leukaemia and those undergoing bone marrow transplantation . The study drug was given throughout the period of neutropenia and sample s were obtained at weekly intervals . Of the 23 patients in each group , 11 of those given fluconazole and 12 placebo recipients were colonized at entry . The commonest sites were the oropharynx and rectum and C and ida albicans was the most frequent isolate . Fluconazole led to a marked reduction in colonization by the second week of treatment to 29 % compared with 68 % for those given the placebo . Two-weeks after stopping the study regimen there was little change with yeast being isolated from 33 % and 81 % respectively . Fluconazole was particularly effective in reducing the carriage of C. albicans in the oropharynx from 46 % to 0 - 10 % and in maintaining this throughout prophylaxis . Recovery of C and ida ( Torulopsis ) glabrata from the perianal region steadily increased to around 30 % in both patient groups and while C and ida krusei species were found exclusively in patients given fluconazole , other c and ida were more common in the placebo group . These results demonstrate that by rapidly reducing the colonization of the alimentary tract , fluconazole eliminates the major reservoir for infection with yeasts other than C. glabrata and C. krusei during the critical period of neutropenia Fungal infections are a major problem in patients with hematologic malignancy . Attempts to reduce their frequency with antifungal agents have not been successful . A double-blind , controlled , single-center trial was conducted with 96 consecutive patients undergoing 154 episodes of chemotherapy . Patients received 400 mg of fluconazole or placebo until bone marrow recovery or initiation of intravenous amphotericin B infusions . End points were  amphotericin B use , fungal infection , stable neutrophil count > 0.5 x 10(9)/L , toxicity precluding further fluconazole use , and death . By Kaplan-Meier estimation , the time to initiation of amphotericin B therapy was shorter in 76 patients treated with placebo than in 75 treated with fluconazole ( P = .003 ) . Also , fluconazole reduced the number of febrile days by 20 % ( P = .002 ) and prevented oropharyngeal c and idiasis ( 1/75 vs. 9/76 , P = .018 ) . The frequency of deep mycoses ( 8/76 vs. 8/75 ) and outcome were unaffected . Fluconazole did not have a favorable effect on infection-related health care costs and was associated with prolonged severe neutropenia ( P = .01 ) Oropharyngeal c and idiasis is frequently a complication of patients with altered immune states .  Clotrimazole troches are effective in the treatment of C and ida and were evaluated in this study in a prophylaxis regimen . Patients with malignant neoplasms who were receiving chemotherapy and renal transplant recipients who were receiving immunosuppressives were r and omized to receive either clotrimazole ( 10 mg ) or placebo troches three times a day in a prospect i ve , double-blinded study . Eighty-four patients were r and omized into the study , 18 patients with leukemia , 19 patients with malignant neoplasms , and 47 patients with renal transplants . Among all patients , thrush developed in 57 % while receiving placebo compared with 13 % while receiving clotrimazole prophylaxis . Prophylaxis showed significant benefit for the renal transplant recipients and for patients with solid malignant neoplasms , but not for the leukemic patients . Clotrimazole troches are effective in preventing oral c and idiasis in a select group of patients We determined whether ketoconazole prophylaxis might reduce C and ida colonization and infections in adult patients with acute leukaemia . During first-remission induction therapy 50 patients were treated with 200 mg ketoconazole administered orally daily , while 57 patients received placebo  in a double-blind , r and omized trial . The duration of severe neutropenia ( granulocytes less than 0.1 x 10(9 ) l-1 ) represented 36 % of the study period in the ketoconazole group and 26 % in the placebo group ( P = 0.043 ) . Although fewer patients presented with positive C and ida surveillance cultures and serological evidence of C and ida infection in the ketoconazole group compared to the placebo group , two c and idaemias and one Trichosporum fungaemia were observed in the ketoconazole group . Moreover , significantly more bacteraemias were noted in the ketoconazole group ( n = 37 ) than in the placebo group ( n = 21 ) ( P = 0.004 ) . Thus , although oral ketoconazole prophylaxis might be associated with less C and ida colonization and fewer seroconversions , it also result ed in more bacteraemias and longer duration of severe neutropenia , suggesting that caution should be exercised when ketoconazole ( or related drugs ) is given to this group of immunocompromised hosts Oral mucositis is a dose-limiting toxicity of intensive chemotherapy . It is caused directly by the cytotoxic effect of chemotherapeutic agents and indirectly by sustained neutropenia . Severe oral mucositis is an important predisposing factor for life-threatening septic complications during aplasia . It also reduces quality of life . At present , no effective causal prophylaxis or treatment against oral mucositis is established . We performed a prospect i ve r and omised placebo-controlled trial using topical oral r-metHuG-CSF ( filgrastim ) in high- grade lymphoma patients treated according to the B-NHL protocol , which contains high-dose methotrexate and causes severe oral mucositis ( WHO grade s I – IV ) in > 50 % of patients . Between August 1996 and July 1997 , a total of 32 chemotherapy cycles were documented in eight patients ( four male , four female ) . Mucosal erythema and ulceration were recorded . All patients assessed their oral pain and impact on swallowing daily , using a subjective scale from no to maximal discomfort ( 1–10 ) . In addition , oral mucositis was assessed according to the WHO score  . Filgrastim was administered in 16 cycles as a viscous mouthrinse ( carboxymethyl- cellulose 2 % , oleum citrii ) 4 × 120 μg/day from days 10 to 16 . Sixteen cycles were given to control patients , of these 14 with placebo , and another two cycles with no treatment . Severe mucositis ( WHO grade III/IV ) was documented in 21 of 32 cycles ( 65.5 % ) . A difference of borderline significance was observed for the reduction of maximum severity of oral mucositis  between G-CSF vs placebo ( P = 0.058 ) , with a reduction of WHO grade IV of 50 % ( four G-CSF vs eight control ) . The number of days in hospital was reduced significantly in the G-CSF group ( P = 0.02 ) . In conclusion , topical oral G-CSF mouthrinses may be beneficial to reduce oral mucositis In some clinical situations the endogenous production of glutamine may be insufficient to maintain optimal tissue structure and function such that glutamine becomes a conditionally essential amino acid . Studies in laboratory animals have demonstrated that glutamine supplementation can reduce the incidence and severity of cytotoxic-induced mucositis . This study examined the role of oral glutamine supplementation in the management of mucositis caused by 5-fluorouracil ( 5-FU ) and folinic acid .  Twenty-eight patients with gastrointestinal cancers were r and omised to receive 16 g of glutamine per day for 8 days , or placebo , in a r and omised double-blind trial before crossing over to the alternative supplement during the second treatment cycle . The supplement was well tolerated with no apparent adverse effects , but failed to have any significant effect on oral mucositis assessed by the patients or investigator . The possible reasons for this apparent lack of benefit are discussed Disruption of the oral mucosal lining and the lack of normal defense mechanisms predispose bone marrow transplant ( BMT ) patients to life-threatening infections , often caused by oral flora . Chlorhexidine , used as an oral antiseptic , appears promising in limiting oral bacteria and fungi , and therefore , may decrease oral complications associated with BMT . The purpose of this study was to determine in pediatric BMT recipients if a 0.12 % chlorhexidine mouthrinse , used as an adjunct to normal in-hospital oral care regimens , would decrease the severity of oral mucositis as measured by oral ulcerations , bacteremia , and length of hospital stay .  Forty-seven pediatric BMT subjects were included in this double-blind study . Subjects were instructed to use 15 ml of a mouthrinse 3 times daily to be swished and gargled for 30 sec. Each subject had 7 oral sites scored for the percentage of ulcerated mucosa twice weekly until day + 35 or hospital discharge or death . Blood was cultured daily during neutropenia . Additionally , the number of days from onset of cytoreduction to hospital discharge or death was recorded for each subject . Alpha was set at .05 . There was no significant difference in the severity of oral ulceration between the chlorhexidine and placebo groups ( P = .18 ) . Chlorhexidine did not reduce the development of bacteremia ( P greater than .5 ) , nor did it significantly decrease the length of hospital stay ( P = .68 ) . ( ABSTRACT TRUNCATED AT 250 WORDS From April 1993 to September 1993 , 15 patients with lymphoid or solid neoplasms underwent 16 non-cryopreserved peripheral stem cell transplantation courses using the  ICE ( ifosfamide , carboplatin , etoposide )  program . They were r and omized in a double-blind clinical trial to received oral misoprostol or placebo for mucositis prophylaxis . The active drug or placebo administration began jointly with chemotherapy at day -4 and was continued until day 16 . The mucositis incidence and severity was significantly higher in patients who received misoprostol . We found no differences regarding myelosuppression , infections or other chemotherapy complications . Our results do not support the use of oral misoprostol as administered in this study , for high-dose chemotherapy-induced mucositis prophylaxis Fifty-six untreated patients with acute leukemia ( 38 acute myelogenous leukemia , 16 acute lymphoblastic leukemia , and 2 blast crisis of chronic granulocytic leukemia ) were r and omized on admission to one of three groups -- one to receive oral antic and idal prophylaxis through the period of remission induction chemotherapy with nystatin , another to receive natamycin , and the third to receive no antic and idal prophylaxis . Neither of the first two groups show any advantage over the last and it is concluded that provided gut sterilization regimes are not employed , prophylactic oral antic and idal treatment is of no value in these patients and should be reserved until there is clinical evidence of infection Patients receiving cytotoxic antineoplastic therapy often have treatment-associated stomatitis . A 0.12 % chlorhexidine 
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In conclusion , there is weak and unreliable evidence that ice chips prevent mucositis .
There is evidence that prophylactic use of antifungal agents , which are absorbed or partially absorbed from the gastrointestinal tract , reduce the clinical signs of oral c and idiasis