title: Role of preoperative versus postoperative itraconazole in allergic fungal rhinosinusitis.
abstract: Antifungals used as adjuvant to surgery in AFRS (Allergic Fungal Rhinosinusitis) have shown varying success in delaying recurrences. Itraconazole has been used both as preoperative and postoperative adjuvant. This study investigates the role of itraconazole in AFRS and compares its role between preoperative and postoperative administration of the drug. Patients were randomly divided into groups as: Group 1 (n = 25), received 4 weeks itraconazole in the preoperative period and operated subsequently, Group 2 (n = 25), received 4 weeks itraconazole in the postoperative period, Group 3 (n = 50), matched patients of AFRS, who didn't receive itraconazole. All the groups received oral steroids in tapering doses staring from 1 mg/kg for 6 weeks in the postoperative period. Symptomatic (SNOT 20), radiologic (Lund Mackay, LM) scores and endoscopic (Kupferberg's NE Grades) were noted. Primary postoperative follow-up was for 24 weeks with routine CT scans and nasal endoscopies, followed by which all the patients were followed with nasal endoscopies only with CT scans when required. Both preoperative and postoperative itraconazole showed significant improvement in the SNOT, LM, and Kupferberg's grades in the follow-up period. Preoperative itraconazole therapy showed significantly better results compared to postoperative itraconazole therapy though the recurrence rates were similar in both groups. Itraconazole is a better preoperative adjunct in AFRS than postoperative.
authors.affiliation: Department of Otolaryngology, Head and Neck surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India- 160012.
authors.forename: Roshan K
authors.initials: RK
authors.lastname: Verma
authors.affiliation: Department of Otolaryngology, Head and Neck surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India- 160012.
authors.forename: Sourabha K
authors.initials: SK
authors.lastname: Patro
authors.affiliation: Department of Otolaryngology, Head and Neck surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India- 160012.
authors.forename: Abhilash Alex
authors.initials: AA
authors.lastname: Francis
authors.affiliation: Department of Otolaryngology, Head and Neck surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India- 160012.
authors.forename: Naresh K
authors.initials: NK
authors.lastname: Panda
authors.affiliation: Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India- 160012.
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
authors.affiliation: Department of Radio diagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India- 160012.
authors.forename: Paramjeet
authors.initials: P
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000188:drug therapy*; D010256:Paranasal Sinuses / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D065631:Rhinitis, Allergic / Q000209:etiology / Q000382:microbiology / Q000473:pathology / Q000628:therapy*; D012852:Sinusitis / Q000209:etiology / Q000382:microbiology / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole
keywords: Allergic fungal rhinosinusitis; Itraconazole; adjuvant antifungal therapy in AFRS; postoperative Itraconazole; preoperative Itraconazole