title: Topical and systemic antifungal therapy for the symptomatic treatment of chronic rhinosinusitis.
abstract: BACKGROUND
  Chronic rhinosinusitis (CRS) is an inflammatory disorder of the nose and sinuses. Since fungi were postulated as a potential cause of CRS in the late 1990s, there has been increasing controversy about the use of both topical and systemic antifungal agents in its management. Although interaction between the immune system and fungus has been demonstrated in CRS, this does not necessarily imply that fungi are the cause of CRS or that antifungals will be effective its management.
  
  
  OBJECTIVE
  To assess the effectiveness of topical or systemic antifungal therapy in the treatment of CRS.
  
  
  METHODS
  We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 8 March 2011.
  
  
  METHODS
  All randomised, placebo-controlled trials considering the use of topical or systemic antifungal therapy in the treatment of CRS and allergic fungal sinusitis (AFS). CRS was defined using either the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) or American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) criteria.
  
  
  METHODS
  We reviewed the titles and abstracts of all studies obtained from the searches and selected trials that met the eligibility criteria. We extracted data using a pre-determined data extraction form. There was significant heterogeneity of outcome data reporting with reports containing both parametric and non-parametric representations of data for the same outcomes. Means and standard deviations for change data were unavailable for a number of trials. Due to the limited reported data, we contacted authors and used original data for data analysis.
  
  
  RESULTS
  Six studies were included (380 participants). Five studies investigated topical antifungals and one study investigated systemic antifungals. The risk of bias in all included studies was low, with all trials being double-blinded and randomised. Pooled meta-analysis showed no statistically significant benefit of topical or systemic antifungals over placebo for any outcome. Symptom scores in fact statistically favoured the placebo group. Adverse event reporting was statistically significantly higher in the antifungal group.
  
  
  CONCLUSIONS
  On the basis of this meta-analysis, there is no evidence to support the use of either topical or systemic antifungal treatment in the management of CRS.
authors.affiliation: St Vincent's Clinical School, St Vincent's Hospital, 806/438 Victoria St, Darlinghurst, Sydney, Australia, NSW 2010.
authors.forename: Peta-Lee
authors.initials: PL
authors.lastname: Sacks
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Harvey
authors.forename: Janet
authors.initials: J
authors.lastname: Rimmer
authors.forename: Richard M
authors.initials: RM
authors.lastname: Gallagher
authors.forename: Raymond
authors.initials: R
authors.lastname: Sacks
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D006801:Humans; D009181:Mycoses / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012220:Rhinitis / Q000188:drug therapy* / Q000382:microbiology; D012852:Sinusitis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000935:Antifungal Agents