The Role of Antifungal Therapy in the Prevention of Recurrent Allergic Fungal Rhinosinusitis after Functional Endoscopic Sinus Surgery: A Randomized, Controlled Study

Khalil, Yasser; Tharwat, Adel; Ag, Abdou; Essa, Enas Said; Ah, Elsawy; Elnakib, O; Nf, Elnaidany

doi:10.1177/014556131109000815

Cited by 42 publications

(37 citation statements)

References 24 publications

(30 reference statements)

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“…Although fungal infections have been implicated pathophysiologically in diverse allergic airway diseases [18,20,26,31,32], treatment with antifungals has not been unequivocally beneficial. Treatment with itraconazole reportedly improved asthma symptoms [22] prompting sporadic use of antifungals in others with positive fungal cultures [20][21][22]25], but the lack of efficacy of voriconazole in asthmatics [23] called to question the value of these agents and prompted us to evaluate outcomes of similar asthmatics treated with antifungals in our clinic.…”

Section: Benefits Of Antifungal Therapy In Asthma Patientsmentioning

confidence: 99%

Benefits of antifungal therapy in asthma patients with airway mycosis: A retrospective cohort analysis

Tsai

Maskatia

et al. 2018

Immunity Inflam & Disease

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IntroductionFungal airway infection (airway mycosis) is increasingly recognized as a cause of asthma and related disorders. However, prior controlled studies of patients treated with antifungal antibiotics have produced conflicting results. Our objective is to measure the effect of antifungal therapy in moderate to severe adult asthmatics with positive fungal sputum cultures in a single center referral‐based academic practice.MethodsWe retrospectively evaluated 41 patients with asthma and culture‐proven airway mycosis treated with either terbinafine, fluconazole, itraconazole, voriconazole, or posaconazole for 4 to >12 weeks together with standard bronchodilator and anti‐inflammatory agents. Asthma control (1 = very poorly controlled; 2 = not well controlled; and 3 = well controlled), peak expiratory flow rates (PEFR), serum total IgE, and absolute blood eosinophil counts before and after antifungal therapy were assessed. In comparison, we also studied nine patients with airway mycosis and moderate to severe asthma who received standard therapy but no antifungals.ResultsTreatment with azole‐based and allylamine antifungals was associated with improved asthma control (mean change in asthma control 1.72–2.25; p = 0.004), increased PEFR (69.4% predicted to 79.3% predicted, p = 0.0011) and markedly reduced serum IgE levels (1,075 kU/L to 463 kU/L, p = 0.0005) and blood eosinophil counts (Mean absolute count 530–275, p = 0.0095). Reduction in symptoms, medication use, and relapse rates decreased as duration of therapy increased. Asthmatics on standard therapy who did not receive antifungals showed no improvement in asthma symptoms or PEFR. Antifungals were usually well tolerated, but discontinuation (12.2%) and relapse (50%) rates were relatively high.ConclusionAntifungals help control symptoms in a subset of asthmatics with culture‐proven airway mycosis. Additional randomized clinical trials are warranted to extend and validate these findings.

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Section: Benefits Of Antifungal Therapy In Asthma Patientsmentioning

confidence: 99%

Benefits of antifungal therapy in asthma patients with airway mycosis: A retrospective cohort analysis

Tsai

Maskatia

et al. 2018

Immunity Inflam & Disease

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“…Typical topical agents include topical antifungal agents, steroids, surfactants, xylitol and topical antibiotics [7–11]. Of these agents, mupirocin also has significant anti-staphylococcal activity.…”

Section: Introductionmentioning

confidence: 99%

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

Kim

Kwon

2016

PLoS ONE

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BackgroundSaline irrigation of the nasal cavity is a classic and effective treatment for acute or chronic rhinosinusitis. Topical antibiotics such as mupirocin have been widely used for recalcitrant chronic rhinosinusitis. Therefore, the purpose of this study was to evaluate the effect of saline irrigation using mupirocin.MethodsA systematic literature review and meta-analysis of mupirocin saline irrigation were performed using EMBASE, MEDLINE, and Cochrane library through December 2015. Data were analyzed with R 3.2.2 software. A random effects model was used because of the diversity of included studies. Sensitivity analysis of particular tested groups and single proportion tests were also performed. The main outcome measure was residual staphylococcal infection, as confirmed by culture or PCR.ResultsTwo RCTs, two prospective studies and two retrospective studies were included. A random effects model meta-analysis of the pooled data identified a relative risk of residual infection of 0.13 (95% CI: 0.06–0.26, p<0.05) with low heterogeneity (I2 = 0%). The proportion of residual staphylococcal infections after 1 month was 0.08 (95% CI: 0.04–0.16). However, this proportion increased to 0.53 at 6 months (95% CI: 0.27–0.78).ConclusionsThe short-term use of mupirocin has a strongly reductive effect on staphylococcal infection in chronic rhinosinusitis. Although there is currently a lack of clear evidence, future studies with well-designed inclusion criteria and randomized controlled trials are needed to examine mupirocin’s long-term effect on chronic rhinosinusitis.

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“…Khali Y et al in their study to assess the effect of systemic and topical antifungal agents -both separately and in combination -in preventing recurrence of AFRS following functional endoscopic sinus surgery (FESS) concluded that the recurrence rate of AFS in patients is low. 10 AFS represents a type 1 and type III hypersensitivity reaction to the fungal hyphae 4. But, recently some studies, however, report good result with the use of systemic itraconazole therapy.…”

Section: Groupmentioning

confidence: 99%

Clinical Evaluation of Effectiveness of Itraconazole in Preoperative and Refractory Postoperative Patients of Allergic Fungal Sinusitis

Venkatasubbaiah¹,

Ahmed²

2016

jebmh

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BACKGROUND Allergic Fungal Sinusitis (AFS) is a noninvasive type of fungal sinusitis, clinically and pathologically a unique entity of chronic rhinosinusitis. The aetiology, pathogenesis, and treatment of AFS are subject to controversy. In spite of aggressive endoscopic surgery, pre-and postoperative steroids and immunotherapy recurrence rates are high. Many additions are made to its original description and management since its early description in 1980. The aim of the present paper was to evaluate clinically. The response to high-dose itraconazole before endoscopic sinus surgery and in refractory postoperative patients. Related literature was reviewed in the light of the present study. MATERIALS AND METHODS A 2 year prospective study conducted on 68 AFS patients divided into two groups to clinically evaluate the results after using oral itraconazole preoperatively in one group and in refractory postoperative period in another. RESULTS The mean age of patients with typical AFS was 36±3.9 years. Patients with AFS with an average follow up of 21 months were included. Recurrence was 6/34 (17.64%) in itraconazole group and revision FESS done in 3/34 (08.82%). Recurrence in patients without itraconazole was 16/34 (47.05%) and refractory to conventional treatment, but responded to itraconazole in 14/16 (87.50%). Revision surgery required in 2/16 (12.50%) after starting oral itraconazole. No side effects or reactions were observed in a total of 7920 doses administered. CONCLUSION Itraconazole is well tolerated by patients and effective in shrinking the polyposis preoperatively with low recurrence. Postoperative refractory AFS is amenable in (87.50%) of patients avoiding repeat FESS. Overall, low recurrence rate and minimizing revision surgery when compared to patients treated without itraconazole was evident in the study.

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The Role of Antifungal Therapy in the Prevention of Recurrent Allergic Fungal Rhinosinusitis after Functional Endoscopic Sinus Surgery: A Randomized, Controlled Study

Cited by 42 publications

References 24 publications

Benefits of antifungal therapy in asthma patients with airway mycosis: A retrospective cohort analysis

Benefits of antifungal therapy in asthma patients with airway mycosis: A retrospective cohort analysis

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

Clinical Evaluation of Effectiveness of Itraconazole in Preoperative and Refractory Postoperative Patients of Allergic Fungal Sinusitis

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