Future topical medications in chronic rhinosinusitis

Abstract

Background:Research has progressed rapidly in recent decades to be er understand the etiopathogenesis and management paradigms of chronic rhinosinusitis (CRS). Although oral antibiotics o en mitigate symptoms in acute CRS exacerbations, eradication of polymicrobial biofilms and multidrug-resistant bacteria remains a challenge. The goal of this review is to summarize and discuss the potential and pitfalls of topical medications in the treatment of CRS. Methods:A related literature review was performed using PubMed and Scopus, with only the English database included. Results:The main therapies were selected and separated in sections. Details regarding future topical treatments of CRS were summarized and discussed. Conclusion:The ease of access of the sinonasal mucosa positions CRS as a disease with high potential for local topical treatment. The ultimate adoption of topical agents will require continued expansion of our understanding of novel local targets in CRS as well as improved methods to deliver and retain the drug of interest at the site of activity. C 2019 ARS-AAOA, LLC.

Current Perspective on Nasal Delivery Systems for Chronic Rhinosinusitis

“…Multidrug-resistant bacteria and polymicrobial biofilms are still a major challenge [33]. Topical antibiotic agents are a research hotspot recently because they can provide higher concentrations of antibiotics locally and limited systemic absorption [34].…”

Anti-biofilm activity of bacteriophages and lysins in chronic rhinosinusitis

“…Still, eradication of polymicrobial biofilms and multidrug-resistant bacteria occurring in CRS remains a challenge (Miyake and Bleier, 2019). Oral antibiotics often mitigate symptoms in acute CRS exacerbations, but they also often fail to eradicate biofilm.…”

The Potential Role of Bacteriophages in the Treatment of Recalcitrant Chronic Rhinosinusitis

“…Biofilm formation makes bacteria 100-1000 fold more resistant to antibiotics by reducing the ability of antibiotics to penetrate the bacteria, by expressing resistance genes and by inducing changes in cellular metabolisms [9,10]. The last decade, different antibiofilm agents have been proposed to treat difficult-to-treat polymicrobial biofilms, e.g., colloidal silver, probiotic irrigations, Manuka honey, surfactants (i.e., baby shampoo) and xylitol [11]. However, data on these biofilm treatments remain limited and the additional benefits remain unclear.…”

“…However, this was not the case in some centers in the former Soviet Union and Eastern Europe, where phage therapy remained common practice. Today, mainly due to the increasing threat of antimicrobial resistance, the concept of phage therapy is regaining popularity in Western Europe [11].…”