title: A randomized trial of mupirocin sinonasal rinses versus saline in surgically recalcitrant staphylococcal chronic rhinosinusitis.
abstract: OBJECTIVE
  Chronic rhinosinusitis (CRS) recalcitrant to surgery is a frustrating clinical entity. Recently, mupirocin sinonasal rinses have been suggested as an efficacious treatment alternative in these patients where Staphylococcus aureus infection is demonstrated. To our knowledge, how best to treat this S aureus reservoir has not been previously evaluated in a double-blinded, randomized, placebo-controlled trial.
  
  
  METHODS
  Prospective, double-blinded, placebo-controlled study.
  
  
  METHODS
  Twenty-five S aureus-positive CRS patients with persistent sinonasal infection despite endoscopic sinus surgery received either a 1-month, twice-daily treatment course of mupirocin sinonasal rinses (MUP) or saline rinses (CON). The primary outcome was S aureus-culture negativity at the conclusion of treatment; secondary rhinological outcomes included subjective and objective measures of rhinosinusitis.
  
  
  RESULTS
  Twenty-two patients satisfactorily completed the treatment period. Of CON patients, 0/13 (0.0%) returned an S aureus-negative sinonasal culture at 1 month, compared to 8/9 (88.9%) of MUP patients (P < .01). Improvements in rhinological outcomes observed in MUP patients following treatment were not subsequently evident when these patients were followed up at a delayed assessment 2 to 6 months after completing treatment.
  
  
  CONCLUSIONS
  Mupirocin sinonasal rinses are an effective short-term anti-S aureus treatment in surgically recalcitrant CRS as assessed by microbiological and selected rhinological outcomes, although the latter improvements may not be durable with time.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Adelaide and Flinders University, Adelaide, Australia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Jervis-Bardy
authors.forename: Samuel
authors.initials: S
authors.lastname: Boase
authors.forename: Alkis
authors.initials: A
authors.lastname: Psaltis
authors.forename: Andrew
authors.initials: A
authors.lastname: Foreman
authors.forename: Peter-John
authors.initials: PJ
authors.lastname: Wormald
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage*; D055556:Nasal Lavage; D009666:Nose / Q000382:microbiology; D012220:Rhinitis / Q000188:drug therapy* / Q000601:surgery; D012852:Sinusitis / Q000188:drug therapy* / Q000601:surgery; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin