Evidence-based recommendations for antimicrobial nasal washes in chronic rhinosinusitis.
BACKGROUND
Chronic rhinosinusitis (CRS) refractory to medical and surgical therapy is a difficult problem for patients and physicians. Topical antimicrobial nasal irrigations are commonly used for treatment with great variation in methodology and without clear scientific support for current treatment formulations. The purpose of this study was to develop a scientific rationale for creating standardized recommendations for clinical practice in the use of topical antimicrobial washes for CRS.


METHODS
An extensive review of basic science and clinical literature on the treatment of CRS with topical antimicrobial washes was completed. Pharmacokinetics of and organism susceptibility to appropriate topically applied antimicrobial agents were reviewed.


RESULTS
The most common organisms associated with CRS were identified. The relevant pharmacokinetics of drugs targeted at these organisms are presented. Susceptibility breakpoints set by the National Committee for Clinical Laboratory Standards are identified to help establish the most effective concentration of the identified drugs. Recommendations for agent selection, agent concentration, length of treatment, dosing schedule, and methods of irrigation are presented.


CONCLUSIONS
Antimicrobial nasal washes provide a potentially effective treatment for the growing population of patients who remain symptomatic after appropriate medical and surgical intervention. This study establishes the basic principles supporting this treatment option and offers rational, evidence-based treatment guidelines. The study has identified additional areas that need to be investigated before prospective clinical trials can be effectively undertaken.
Elliott
Kimberly A
KA
Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
Stringer
Scott P
SP
D000281:Administration, Intranasal; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D002908:Chronic Disease; D002981:Clindamycin / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology; D019317:Evidence-Based Medicine; D006801:Humans; D015242:Ofloxacin / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology; D012008:Recurrence; D012220:Rhinitis / Q000628:therapy*; D012852:Sinusitis / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000379:methods*; D014031:Tobramycin / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002981:Clindamycin; D015242:Ofloxacin; D014031:Tobramycin