Nebulized Antibiotics for the Treatment of Refractory Bacterial Chronic Rhinosinusitis

Nebulized Antibiotics for the Treatment of Refractory Bacterial Chronic Rhinosinusitis

OBJECTIVE: To review the safety and efficacy of nebulized antibiotics for refractory bacterial chronic rhinosinusitis (CRS) in adults. DATA SOURCES: PubMed (up to February 2011) and The Cochrane Library (up to February 2011) were searched using the terms nebulizer, nebulized, antibiotics, and chroni...

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Bibliographic Details
Published in:Annals of Pharmacotherapy Vol. 45; no. 6; pp. 798 - 802
Main Authors: Woodhouse, Brittany Mae, Cleveland, Kevin W
Format: Book Review Journal Article
Language:English
Published: Los Angeles, CA SAGE Publications 01-06-2011
Whitney
Subjects:
Administration, Inhalation
Adult
Anti-Bacterial Agents - administration & dosage
Anti-Bacterial Agents - adverse effects
Anti-Bacterial Agents - therapeutic use
Bacteria
Bacterial Infections - drug therapy
Bacterial Infections - microbiology
Biological and medical sciences
Chronic Disease
Humans
Medical sciences
Nebulizers and Vaporizers
Non tumoral diseases
Otorhinolaryngology. Stomatology
Pharmacology. Drug treatments
Rhinitis - complications
Rhinitis - drug therapy
Rhinitis - microbiology
Sinusitis - complications
Sinusitis - drug therapy
Sinusitis - microbiology
Treatment Outcome
Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
chronic rhinosinusitis
nebulizer
antibiotics
chronic sinusitis
Delivery system
Human
Nose disease
Treatment resistance
Rhinitis
Sinusitis
Infection
Antibiotic
Chronic
Treatment
Bacteriosis
ENT disease
Bacteria
Paranasal sinus disease
Nebulizer
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Summary:OBJECTIVE: To review the safety and efficacy of nebulized antibiotics for refractory bacterial chronic rhinosinusitis (CRS) in adults. DATA SOURCES: PubMed (up to February 2011) and The Cochrane Library (up to February 2011) were searched using the terms nebulizer, nebulized, antibiotics, and chronic sinusitis. STUDY SELECTION AND DATA EXTRACTION: All English-language articles reporting clinical trials in adults were evaluated; 4 relevant studies were identified. DATA SYNTHESIS: Conventional therapy for CRS, including pharmacologic treatments (eg, oral antibiotics, corticosteroids, antihistamines) and surgery, are not effective for all patients, which has led to experimentation with nebulized antibiotics. The 4 trials analyzing the effectiveness of nebulized antibiotics for refractory CRS in adults identified in our literature search were diverse in their methods, and different antibiotics were used in each trial. Furthermore, all of the trials had small sample sizes, with the largest comprising 42 patients. Two of the studies compared nebulized antibiotics to nebulized saline, and even though rhinosinusitis symptoms improved, nebulized antibiotics were found to offer no additional benefit over saline. The 2 other trials had no control groups and found that nebulized antibiotics led to an improvement in symptoms. In 1 trial, antibiotics were selected based on the results of sinus cultures, which led to infection resolution in 38 of 50 (76%) treatment courses. Nebulized antibiotics were well tolerated, with only minor adverse effects noted. CONCLUSIONS: Based on current studies, use of nebulized antibiotics for refractory CRS cannot be recommended at this time. Although supportive evidence is limited, nebulized antibiotics appear to improve rhinosinusitis symptoms in some patients with minimal adverse effects. With further studies, culture-directed nebulized antibiotic therapy may be a treatment option in patients with CRS refractory to conventional treatments.
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ISSN:1060-0280
1542-6270
DOI:10.1345/aph.1P723