Effect of topical ofloxacin on bacterial biofilms in refractory post-sinus surgery rhino-sinusitis

Abstract

Bacterial biofilms have been shown to play a major role in many chronic infections, in addition, there is growing evidence that bacterial biofilms may play a role in some forms of refractory CRS that persists despite proper surgery and culture directed antibiotic therapy. The objective is to determine the effect of application of topical ofloxacin on nasal and sinus mucosa in patients with proven existence of bacterial biofilms and persistent chronic sinusitis after FESS. The study design is a prospective controlled study. The study included a total of 12 patients who had refractory CRS in spite of undergoing FESS for that specific reason (study group), and control group (involved 25 patients), for whom FESS was done, with complete improvement postoperatively in 15 of them, and persistence of symptoms in the other ten. Topical ofloxacin eye drops (0.3 %) tds for 12 weeks were prescribed for (study group), culture and sensitivity and scanning electron microscopy were done for middle meatal mucosal specimens for all patients and controls, all of them were followed up for a minimum of 9 months (range 9-18 months). Of the study group, 80 % showed marked improvement in the structure of the mucosa, with the regaining of normal respiratory epithelium, with complete disappearance of the biofilm surface, and the remaining 20 % showed only reduction in the number of inflammatory cells and regaining cilia with scattered patches of very thin biofilm. Biofilms formation plays an active role in perpetuating inflammation in CRS patients and enhanced the recurrence and resistance in those patients, we found a statistically significant improvement in patients' group (P < 0.001), after 12 weeks of topical ofloxacin (without any evidence of any side effects). So, we concluded that topical ofloxacin seems to be an effective, tolerable, convenient, cheap and even safe mode of treatment of refractory CRS after FESS due to biofilms' formation. Thus, we recommend such modality of treatment postoperatively especially in refractory cases of CRS.

Mupirocin in the Treatment of Staphylococcal Infections in Chronic Rhinosinusitis: A Meta-Analysis

“…Nasal irrigation works by mechanically removing inflammatory mucin and therefore enhancing mucociliary function [4]. Bacterial biofilms may develop in refractory CRS, which persist after sinus surgery or culture-based antibiotic therapy [5]. However, classic saline irrigation and oral antibiotics have a limited effect on these refractory cases.…”

“…Recently, saline irrigation mixed with a topical agent have been introduced to treat these recalcitrant CRS cases [5,6]. Typical topical agents include topical antifungal agents, steroids, surfactants, xylitol and topical antibiotics [7–11].…”

Topical antibiotic therapy in chronic rhinosinusitis: an update

“…To investigate the effects of topical ofloxacin drops on biofilm formation, Ezzat et al performed a prospective trial on patients with recalcitrant CRS after ESS . Patients who were symptomatic 6 months after sinus surgery and had evidence of biofilm formation on scanning electron‐microscopic (SEM) examination of middle meatal mucosal specimens were treated with 3 drops in each nostril of topical 0.3% ofloxacin every 8 hours for 12 weeks with the head positioned downward for 3 minutes.…”

Hyaluronate effect on bacterial biofilm in ENT district infections: a review

“…There is also evidence of good results being obtained with topical ofloxacin on humans and with nitric oxide on sheep inoculated with S. aureus (26,27).…”