Antifungals used as adjuvant to surgery in AFRS (Allergic Fungal Rhinosinusitis) have shown varying success in delaying recurrences. Itraconazole has been used both as preoperative and postoperative adjuvant. This study investigates the role of itraconazole in AFRS and compares its role between preoperative and postoperative administration of the drug. Patients were randomly divided into groups as: Group 1 (n = 25), received 4 weeks itraconazole in the preoperative period and operated subsequently, Group 2 (n = 25), received 4 weeks itraconazole in the postoperative period, Group 3 (n = 50), matched patients of AFRS, who didn't receive itraconazole. All the groups received oral steroids in tapering doses staring from 1 mg/kg for 6 weeks in the postoperative period. Symptomatic (SNOT 20), radiologic (Lund Mackay, LM) scores and endoscopic (Kupferberg's NE Grades) were noted. Primary postoperative follow-up was for 24 weeks with routine CT scans and nasal endoscopies, followed by which all the patients were followed with nasal endoscopies only with CT scans when required. Both preoperative and postoperative itraconazole showed significant improvement in the SNOT, LM, and Kupferberg's grades in the follow-up period. Preoperative itraconazole therapy showed significantly better results compared to postoperative itraconazole therapy though the recurrence rates were similar in both groups. Itraconazole is a better preoperative adjunct in AFRS than postoperative.
We found improvements in clinical, radiologic, and endoscopic parameters in AFS after preoperative itraconazole administration, which decreased the disease load significantly and also reduced the extent of surgery in the short-term follow-up. It may prove to be a good preoperative adjunct that needs further research.
Background:
Chronic suppurative otitis media (CSOM) is a major cause of hearing disability and morbidity in poor socioeconomic developing countries with prevalence of 4%. Indiscriminate use of antibiotics and poor follow up of patients has resulted in treatment failure, emergence of resistant strains, super infection, intra-cranial and extra-cranial complications in CSOM patients. Staphylococcus aureus, P. aeruginosa, Proteus spp. and Klebsiella spp. are most common organisms causing infection. Knowledge of microbial profile and susceptibility pattern is essential for efficacious treatment of this disorder.
Objective:
To determine the clinico-bacteriological profile of CSOM, to analyze the susceptibility pattern of various antibiotics and to evaluate the in vitro efficacy of aminoglycosides over fluoroquinolones against the aerobic bacterial isolates from CSOM.
Methods:
We studied 153 clinically suspected CSOM cases from March 2018 to October 2018 in Microbiology and Otorhinolaryngology department. The ear swabs were aerobically cultured and identification of the isolate was done by standard bacteriological methods.
Results:
Safe type CSOM was a major cause of disease. Moderate (35.3%) and mild degree (32.7%) of hearing loss was seen in most of the CSOM cases. The culture positivity rate was 82.4% and the most common isolate was P. aeruginosa (55.8%) followed by S. aureus (27.5%). P. aeruginosa, A. baumannii and Enterobacteriaceae spp. showed high sensitivity to colistin, piperacillin-tazobactam, ceftazidime-tazobactam and good sensitivity for cefepime and amikacin; 33.3% S. aureus isolates were Methicillin-resistant which was sensitive to gentamicin, vancomycin and linezolid.
Conclusion:
Knowledge of the spectrum of microorganisms causing ear discharge is important for effective treatment.
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