Topical therapy for refractory rhinosinusitis caused by methicillin-resistant Staphylococcus aureus : First report in a prospective series

Shikani, Alan H.; Khoueir, Nadim; Jabra‐Rizk, Mary Ann; Shikani, Henry J.; Basaraba, Randall J.; Leid, Jeff G.

doi:10.1016/j.anl.2018.01.009

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…Several studies looking at the effect of topical antibiotics included patients who received concurrent oral antibiotics ( Jervis-Bardy et al., 2012 ; Ezzat et al., 2015 ; Shikani et al., 2018 ). These studies did not find an impact with the use of oral antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic outcomes in patients with AERD treated with topical antibiotics and intranasal corticosteroids

Martinez-Paredes

Choby

Marino

et al. 2022

Front. Cell. Infect. Microbiol.

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BackgroundIdentifying effective therapy for recalcitrant chronic rhinosinusitis with nasal polyposis (CRSwNP) is a major challenge; and subtypes such as aspirin-exacerbated respiratory disease (AERD) are even more difficult to treat. Evidence on topical antibiotics use in (CRSwNP) is lacking. Current consensus guidelines recommend against its routine use, but recent reviews show some benefit when managing recalcitrant disease after endoscopic sinus surgery (ESS).ObjectiveEvaluate the effect of culture-directed topical antibiotics on sinonasal outcomes in AERD patients with a positive perioperative sinonasal bacterial culture who have undergone ESS.MethodsA retrospective cohort study of AERD patients with positive sinonasal culture, who underwent ESS from 2016 to 2021 was performed. Forty-four patients were identified and stratified based on their postoperative medical treatment. Twenty-six underwent postoperative intranasal corticosteroids (INCS) alone, while eighteen underwent INCS plus a 4-weeks treatment with topical antibiotics. SNOT-22 and Lund-Kennedy score (LKS) were assessed preoperatively and at 4-weeks and 4-6 months after ESS.ResultsA statistically significant improvement in the 4-weeks and 4-6 months postoperative SNOT-22 and LKS were noted within both groups (p<0.05). However, only a statistically significant difference was found in the 4-weeks postoperative LKS when comparing between treatment groups (p=0.01). Our linear regression model demonstrated a relationship between the use of combined therapy with INCS and topical antibiotics and the LKS 4-weeks post ESS (p=0.015).ConclusionIn AERD patients with a confirmed sinus infection, the combination of culture-directed topical antibiotics and intranasal corticosteroid irrigations in the postoperative period can provide a short-term improvement in endoscopic scores.

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Section: Discussionmentioning

confidence: 99%

Endoscopic outcomes in patients with AERD treated with topical antibiotics and intranasal corticosteroids

Martinez-Paredes

Choby

Marino

et al. 2022

Front. Cell. Infect. Microbiol.

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“…A retrospective study of 58 patients with recalcitrant CRS treated with high-volume topical antibiotics via irrigation based on nasal culture results (vancomycin, levofloxacin, mupirocin, gentamicin, ceftriaxone, tobramycin, and ceftazidime) demonstrated an improvement in symptom score and endoscopic appearance [40]. A recent prospective study also showed the superiority of topical antibiotics (vancomycin, mupirocin, tobramycin) combined with topical steroids in methicillin-resistant Staphylococcus aureus eradication compared to topical steroids alone [39,41]. However, because the evidence level of the previous studies was low, The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS2020) disproved the efficacy of topical antibiotics [5,[30][31][32].…”

Section: Antibioticsmentioning

confidence: 99%

Current Perspective on Nasal Delivery Systems for Chronic Rhinosinusitis

2021

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Chronic rhinosinusitis is an upper respiratory disease during which topical drug treatment via the nasal cavity is the most actively utilized therapeutic strategy. In addition to steroids, antibiotics, and antifungal agents, which are widely used in clinical practice, research on novel topical agents to improve the bacterial biofilm or mucociliary clearance remains ongoing. Moreover, owing to the complex structure of the nasal cavity, the effects of nasal drug delivery vary depending on factors related to delivery fluid dynamics, including device, volume, and compounds. In this article, we review methods and compounds that have been applied to chronic rhinosinusitis management and introduce recent advances and future perspectives in nasal drug delivery for upper respiratory diseases.

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Latest developments on topical therapies in chronic rhinosinusitis

Tan

Psaltis

2020

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Topical therapies play an important role in the management of chronic rhinosinusitis (CRS). A detailed literature review was undertaken to appraise recent evidence surrounding current topical therapies and novel treatments used in the setting of recalcitrant CRS. Recent findings Effective sinus surgery aids in the delivery of topical therapies. Budesonide nasal rinses delivered by saline irrigation offer clinical and symptomatic improvements pre and postoperatively with a well-proven safety profile. Topical steroids may additionally offer direct antibacterial effects as per in-vitro testing. Topical antibiotics are not recommended in routine practice; however, they may be of benefit for short-term eradication therapy. Novel treatments are under keen investigation and include bacteriophage, colloidal silver and manuka honey. The evidence base for these treatments is not robust enough to recommend their routine use at present. Summary Topical steroids delivered in conjunction with saline nasal irrigation offer the best combination of treatments in CRS and should be considered a standard of care. Wide surgical access and aggressive surgical debridement of polyposis facilitates the delivery of steroid irrigations to sinonasal mucosa and is associated with improved long-term outcomes following endoscopic sinus surgery. The use of novel treatments remains within the research setting alone.

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Topical therapy for refractory rhinosinusitis caused by methicillin-resistant Staphylococcus aureus : First report in a prospective series

Cited by 4 publications

References 27 publications

Endoscopic outcomes in patients with AERD treated with topical antibiotics and intranasal corticosteroids

Endoscopic outcomes in patients with AERD treated with topical antibiotics and intranasal corticosteroids

Current Perspective on Nasal Delivery Systems for Chronic Rhinosinusitis

Latest developments on topical therapies in chronic rhinosinusitis

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