Antifungal treatment and chronic rhinosinusitis.
Chronic rhinosinusitis (CRS) is an inflammatory disease with a multifactorial etiology. Antifungal therapy is not routinely used to treat it. However, evidence implicating fungi in some forms of CRS recently has been published. Controversy exists as to whether fungi identified in sinonasal cultures are always pathogenic. Immunologic evidence supporting the role of fungi in the pathogenesis of CRS is also debated. Topical antifungal therapy is more widely used than oral therapy, with amphotericin B irrigation being the most common. Although some studies show benefit from this irrigation, others refute the efficacy. Although oral antifungal agents are used uncommonly, itraconazole is the most commonly used drug. The efficacy of oral itraconazole in CRS has never been assessed in a clinical trial. Given the current evidence, the use of antifungals to treat CRS is controversial and has limited indications.
Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Building 105, Room 1870, 2160 South 1st Avenue, Maywood, IL 60153, USA.
Devyani
D
Lal
James A
JA
Stankiewicz
D000281:Administration, Intranasal; D000284:Administration, Oral; D000287:Administration, Topical; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D009181:Mycoses / Q000150:complications*; D012220:Rhinitis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D012852:Sinusitis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B