The effectiveness topical amphotericin B in the management of chronic rhinosinusitis: a meta-analysis

Abstract

Chronic rhinosinusitis (CRS) is believed to be the result of an exaggerated reaction to fungi in the nasal mucosa, and topical amphotericin B (AMB) is a commonly used treatment. The purpose of this study was to perform a meta-analysis of high-quality comparative studies to examine the efficacy of topical AMB for the treatment of CRS. A search was conducted of Medline, Cochrane, EMBASE, and ISI Web of Knowledge until December 31, 2013 using combinations of the search terms chronic rhinosinusitis, human, treatment, antibiotics, nasal irrigation, nebulized, nasal lavage, sinonasal rinses, and antimicrobials. Inclusion criteria were (1) comparative studies, (2) a diagnosis of CRS or chronic sinusitis, and (3) the intervention was a topical antifungal. The primary outcome measure was quality of life (QOL), and the secondary was nasal endoscopy score. Of 235 article initially identified, five randomized controlled trials were included in the meta-analysis. Analysis of four studies with complete QOL data found no difference between treatment and placebo groups [standard difference in means 0.78, 95 % confidence interval (CI) -0.25 to 1.81, P = 0.138]. Analysis of four studies with complete nasal endoscopy score data found no difference between the treatment and placebo groups (standard difference in means 0.34, 95 % CI -0.08 to 0.76, P = 0.117). AMB is not more effective than placebo in improving QOL or nasal endoscopy scores in patients with CRS.

Efficacy of nasal irrigation with 200 μg/mL amphotericin B after functional endoscopic sinus surgery: a randomized, placebo‐controlled, double‐blind study

“…Other controversies include total dosage, treatment duration, and the route of administration. The daily dose ranged from 3 to 20 mg of AMB, and the treatment duration ranged from 4 to 80 weeks . In our present study, a daily dose of 20 mg of AMB was applied, the same as that in our previous study .…”

“…Across different research groups, the methodology of AMB application varies regarding delivery technique, drug concentration, and daily dose . Two recent meta‐analyses reported that topical AMB was not beneficial for CRS . Among the 5 randomized controlled studies enrolled for meta‐analyses, different AMB concentrations had been applied for treatment of CRS.…”

The role of infection and antibiotics in chronic rhinosinusitis.

“…37 Multiple meta-analyses looking at topical antifungal treatment with amphotericin B included several RCTs that met inclusion criteria. 38,39 Results indicated no differences between treatment and placebo groups for quality of life, nasal endoscopy, or symptom scores. In a meta-analysis pooling five studies investigating topical and one study investigating systemic antifungal agents, symptom scores statistically favored placebo, and adverse event reporting was higher in the antifungal group.…”

“…Nearly all have evaluated topical amphotericin, but one recent RCT used topical fluconazole and also found no benefit . Multiple meta‐analyses looking at topical antifungal treatment with amphotericin B included several RCTs that met inclusion criteria . Results indicated no differences between treatment and placebo groups for quality of life, nasal endoscopy, or symptom scores.…”

Evidence and evidence gaps in therapies of nasal obstruction and rhinosinusitis

“…In the EPOS and in a recent review article by Wang et al [149], the recommendation to not use topical amphotericin B is made This is based on the fact, that five RCTs were unable to demonstrate a positive outcome in nasal endoscopy or in the culture of fungi from the nasal mucosa.…”