Amphotericin B nasal lavages: Not a solution for patients with chronic rhinosinusitis - 18/08/11
, Glenis K. Scadding, MA, MD, FRCP b, Lydia Badia, MD, FRCS b, Peter W. Hellings, MD, PhD c, Mark Jorissen, MD, PhD c, Joaquim Mullol, MD, PhD d, Alda Cardesin, MD d, Claus Bachert, MD, PhD e, Thibaut P.J. van Zele, MD e, Marcel G.W. Dijkgraaf, MD, PhD f, Valerie Lund, MS, FRCS, FRCSEd b, Wytske J. Fokkens, MD, PhD a
Reprint requests: Fenna A. Ebbens, MD, Department of Otorhinolaryngology, Head and Neck Surgery, Academic Medical Center, Meibergdreef 9 1105 AZ Amsterdam, The Netherlands.Amsterdam, The Netherlands, London, United Kingdom, Leuven and Ghent, Belgium, and Barcelona, Spain
Abstract |
Background |
Chronic rhinosinusitis (CRS) is one of the most common chronic diseases. Recently, it has been suggested that an exaggerated immune response to fungi is crucial in the pathogenesis of the disease. On the basis of this hypothesis, intranasal treatment with amphotericin B should benefit patients with CRS. Data from 2 uncontrolled and 2 controlled trials are conflicting, however.
Objective |
To clarify the role of intranasal antifungal drugs in the treatment of CRS, we conducted a large, double-blind, placebo-controlled, multicenter study comparing the effectiveness of amphotericin B nasal lavages with placebo.
Methods |
A total of 116 randomly selected patients with CRS were instructed to instill 25 mL amphotericin B (100 μg/mL) or placebo to each nostril twice daily for 3 months. Primary outcomes included a reduction in total visual analog scale (VAS) score and nasal endoscopy score. Secondary outcome measures included peak nasal inspiratory flow, polyp score, quality of life (Short Form-36, Rhinosinusitis Outcome Measure-31), and individual VAS scores.
Results |
Analysis was based on intention to treat and involved all patients randomly assigned. Mean VAS scores, Short Form-36 and Rhinosinusitis Outcome Measure-31 data, peak nasal inspiratory flow values, nasal endoscopy scores, and polyp scores were similar in both treatment groups at the time of randomization, and no significant differences were observed after 13 weeks of treatment.
Conclusion |
Amphotericin B nasal lavages in the described dosing and time schedule do not reduce clinical signs and symptoms in patients with CRS.
Clinical implications |
Amphotericin B nasal lavages in the described dosing and time schedule are ineffective and therefore not advised in the treatment of patients with CRS.
Le texte complet de cet article est disponible en PDF.Key words : Randomized controlled trial, prospective study, double-blind method, human, amphotericin B, intranasal administration, rhinosinusitis, nasal polyps, chronic disease, fungi
Abbreviations used : ASA, CRS, CT, ESS, NP, PNIF, RSOM-31, SF-36, VAS
Plan
| Disclosure of potential conflict of interest: G. K. Scadding has consultant arrangements with GlaxoSmithKline, Schering-Plough, and RhinoPharma, and is on the speakers’ bureau for GlaxoSmithKline, Merck Sharp & Dohme, and Schering-Plough. V. Lund has consultant arrangements with Schering-Plough. W. J. Fokkens has consultant arrangements with GlaxoSmithKline and Schering-Plough. The rest of the authors have declared that they have no conflict of interest. |
Vol 118 - N° 5
P. 1149-1156 - novembre 2006 Retour au numéro
Article précédent
- Efficacy and safety of ciclesonide nasal spray for the treatment of seasonal allergic rhinitis
- Paul H. Ratner, Mark A. Wingertzahn, Julius H. van Bavel, Frank Hampel, Patrick F. Darken, Tushar Shah
- Rapid detection of fungal ⍺-amylase in the work environment with a lateral flow immunoassay
- Jelena Bogdanovic, Marjo Koets, Ingrid Sander, Inge Wouters, Tim Meijster, Dick Heederik, Aart van Amerongen, Gert Doekes
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?