Topical Antimicrobials in the Management of Chronic Rhinosinusitis: A Systematic Review

Background Chronic rhinosinusitis (CRS) is a common disease that can significantly impact health. The mainstay of medical treatment is topical steroids and oral antibiotics, but little is known about the efficacy of topical antibiotics. The purpose of this study was to identify evidence for the use of topical antibiotics in the treatment of CRS and exacerbations of CRS. Methods Systematic review of literature with a search of the MEDLINE, EMBASE, and CINAHL databases; Cochrane Central Register of Controlled Trials (Third Quarter 2007); and Cochrane Database of Systemic Reviews (3rd Quarter 2007) databases were performed. The dates of search were from December 1, 1949 to September 30, 2007. Results Fourteen studies that fulfilled the inclusion criteria were identified: seven were controlled trials and of these, five were double blinded and randomized. Only one of the randomized studies showed a positive outcome. Overall, there was low-level corroborative evidence for the use of antibacterials. No definite conclusions could be made regarding the use of antifungals. Currently, there is evidence for the use of nasal irrigation or nebulization rather than delivery by nasal spray. For the antibacterial studies, the highest level of evidence currently exists for studies that have used postsurgical patients and culture-directed therapy. Both stable and acute exacerbations of CRS appear to benefit from topical antimicrobials. Conclusion Topical antibiotics appear effective in the management of CRS. Given the combination of low-level evidence (level III, with inherent potential confounders of natural progression of disease and placebo effect) and the level IIb evidence being limited to the cystic fibrosis group of patients, topical antibiotics should not be first-line management but may be attempted in patients refractory to the traditional topical steroids and oral antibiotics. Larger and better-designed randomized double-blind placebo-controlled trials are required to more fully evaluate this emerging modality of treatment.

[1]  J. Stankiewicz,et al.  Activity of Nasal Amphotericin B Irrigation against Fungal Organisms in Vitro , 2007, American journal of rhinology.

[2]  M. Desrosiers,et al.  Effectiveness of Topical Antibiotics on Staphylococcus Aureus Biofilm in Vitro , 2007, American journal of rhinology.

[3]  C. Bachert,et al.  Amphotericin B nasal lavages: not a solution for patients with chronic rhinosinusitis. , 2006, The Journal of allergy and clinical immunology.

[4]  M. Citardi,et al.  Treatment of chronic rhinosinusitis exacerbations due to methicillin-resistant Staphylococcus aureus with mupirocin irrigations. , 2006, American journal of otolaryngology.

[5]  R. Rosenfeld,et al.  Systematic review of topical antimicrobial therapy for acute otitis externa , 2006, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[6]  C. Gamble,et al.  Systemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations. , 2006, The Cochrane database of systematic reviews.

[7]  S. Stringer,et al.  Evidence-Based Recommendations for Antimicrobial Nasal Washes in Chronic Rhinosinusitis , 2006, American journal of rhinology.

[8]  H. Ulmer,et al.  Tolerability of N-chlorotaurine in chronic rhinosinusitis applied via yamik catheter. , 2005, Auris, nasus, larynx.

[9]  T. Kingdom,et al.  The microbiology and antimicrobial resistance patterns in chronic rhinosinusitis. , 2004, American journal of otolaryngology.

[10]  Jeannine S. Schiller,et al.  Summary health statistics for U.S. adults: National Health Interview Survey, 2002. , 2004, Vital and health statistics. Series 10, Data from the National Health Survey.

[11]  H. Riechelmann,et al.  Topical antifungal treatment of chronic rhinosinusitis with nasal polyps: a randomized, double-blind clinical trial. , 2004, The Journal of allergy and clinical immunology.

[12]  G. Scadding,et al.  Evaluation of the Medical and Surgical Treatment Of Chronic Rhinosinusitis: A Prospective, Randomised, Controlled Trial , 2004, The Laryngoscope.

[13]  N. Bhattacharyya.  The Economic Burden and Symptom Manifestations of Chronic Rhinosinusitis , 2003, American journal of rhinology.

[14]  D. Sherris,et al.  Intranasal antifungal treatment in 51 patients with chronic rhinosinusitis. , 2002, The Journal of allergy and clinical immunology.

[15]  Winston C. Vaughan,et al.  Use of Nebulized Antibiotics for Acute Infections in Chronic Sinusitis , 2002, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[16]  P. Scheinberg,et al.  Nebulized Antibiotics for the Treatment of Acute Exacerbations of Chronic Rhinosinusitis , 2002, Ear, nose, & throat journal.

[17]  H. Misiołek,et al.  Comparison of the Efficacy and Tolerability of Amoxycillin/Clavulanic Acid 875mg b.i.d. with Cefuroxime 500mg b.i.d. in the Treatment of Chronic and Acute Exacerbation of Chronic Sinusitis in Adults , 2002 .

[18]  M. Desrosiers,et al.  Treatment of Chronic Rhinosinusitis Refractory to Other Treatments with Topical Antibiotic Therapy Delivered by Means of a Large-Particle Nebulizer: Results of a Controlled Trial , 2001, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[19]  Y. Okamoto,et al.  Fosfomycin nebulizer therapy to chronic sinusitis. , 2001, Auris, nasus, larynx.

[20]  R. Metson,et al.  Clinical Outcomes in Patients With Chronic Sinusitis , 2000, The Laryngoscope.

[21]  P. B. Dinis,et al.  Penetration of Cefuroxime Into Chronically Inflamed Sinus Mucosa , 1999, The Laryngoscope.

[22]  D. Sherris,et al.  The diagnosis and incidence of allergic fungal sinusitis. , 1999, Mayo Clinic proceedings.

[23]  W. Bolger,et al.  Topical Antibiotic Therapy for Recalcitrant Sinusitis , 1999, The Laryngoscope.

[24]  D. Kennedy,et al.  Endoscopically Guided Cultures in Chronic Sinusitis , 1998, American journal of rhinology.

[25]  R. Moss,et al.  Management of sinusitis in cystic fibrosis by endoscopic surgery and serial antimicrobial lavage. Reduction in recurrence requiring surgery. , 1995, Archives of otolaryngology--head & neck surgery.

[26]  F. Lecomte,et al.  Study of the efficacy and safety of ciprofloxacin in the treatment of chronic sinusitis. , 1994, Chemotherapy.

[27]  Fairbanks Dn.  Inflammatory diseases of the sinuses: bacteriology and antibiotics. , 1993 .

[28]  R. Wilson,et al.  RELATIVE IMPORTANCE OF ANTIBIOTIC AND IMPROVED CLEARANCE IN TOPICAL TREATMENT OF CHRONIC MUCOPURULENT RHINOSINUSITIS A Controlled Study , 1986, The Lancet.

[29]  D. Sherris,et al.  Treatment of chronic rhinosinusitis with intranasal amphotericin B: a randomized, placebo-controlled, double-blind pilot trial. , 2005, The Journal of allergy and clinical immunology.

[30]  L. Kalogjera,et al.  European Position Paper on Rhinosinusitis and Nasal Polyps , 2007 .

[31]  M. Durand,et al.  Preliminary study of the deposition of aerosol in the maxillary sinuses using a plastinated model. , 2001, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[32]  D. Passali,et al.  Amoxicillin/clavulanate in chronic rhinosinusitis: tissue and serum distribution. , 2001, Acta oto-rhino-laryngologica Belgica.

[33]  T. Tami,et al.  Role of Middle Meatus Aspiration Culture in the Diagnosis of Chronic Sinusitis , 1997, The Laryngoscope.

[34]  M. Hashiba,et al.  Efficacy of long-term administration of clarithromycin in the treatment of intractable chronic sinusitis. , 1996, Acta oto-laryngologica. Supplementum.

[35]  P. Berche,et al.  A double-blind comparison of ciprofloxacin and amoxycillin/clavulanic acid in the treatment of chronic sinusitis. , 1994, Chemotherapy.

[36]  D. Fairbanks.  Inflammatory diseases of the sinuses: bacteriology and antibiotics. , 1993, Otolaryngologic clinics of North America.

[37]  S. Baba,et al.  Topical use of antibiotics for paranasal sinusitis. , 1992, Rhinology. Supplement.