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Odor Management in Fungating Wounds With Metronidazole

A Systematic Review

de Castro, Diana L. V. PhD, RN; Santos, Vera Lucia C. G. PhD, RN, CETN/WOCN (TiSOBEST)

Journal of Hospice & Palliative Nursing: February 2015 - Volume 17 - Issue 1 - p 73–79
doi: 10.1097/NJH.0000000000000125
Feature Articles

Odor is one of the main characteristics of malignant fungating wounds and is caused by the interaction of aerobic and anaerobic microbiota that colonizes and infects wounds. This odor has been described as intolerable and sickening. Antiseptics and antibiotics have been used to reduce local microbial load, and metronidazole topical therapy is the most commonly cited. This study aimed to identify and analyze the scientific evidence supporting the use of metronidazole in fungating wounds. A systematic review was undertaken according to the Cochrane Collaboration guidelines, and the following databases were searched: Cochrane, Lilacs, EMBASE, CINAHL, and PubMed. Of the 258 articles identified and retrieved, we initially selected 26 for full reading, and 14 of these were included in the final selection. Of these 14 studies, 6 are clinical trials, and only 3 of them exclusively used metronidazole in malignant fungating wounds. Of these 3, only 1 study reported a statistically significant (P = .005) advantage of metronidazole use. Despite some evidence for its clinical benefits, the scarcity of studies on the use of metronidazole for odor control in malignant fungating wounds does not allow us to confirm its actual effectiveness. Although we did not find strong scientific evidence supporting the efficacy of metronidazole in odor control through randomized clinical studies or meta-analyses, this study provides the best available evidence thus far for the efficacy of 0.75% to 0.8% metronidazole in the odor control of malignant fungating wounds.

Diana L. V. de Castro, PhD, RN, is Senior Nurse at Continuing Education, Nursing Department, AC Camargo Cancer Center, São Paulo, Brazil. Post doctorade student, Nursing School of the University of São Paulo, Brazil.

Vera Lucia C. G. Santos, PhD, RN, CETN/WOCN (TiSOBEST), is Associate Professor 3 at Medical Surgical Department, Nursing School of the University of São Paulo, Brazil.

Address correspondence to Diana L. V. de Castro, PhD, RN, Nursing Department, AC Camargo Cancer Center R. Prof. Antonio Prudente, 211, Liberdade, São Paulo/SP, 01509-900, Brazil (

No funding was received for this study.

The authors have no conflicts of interest to disclose.

© 2015 by The Hospice and Palliative Nurses Association.