RESEARCH - Evidence-based recommendations for antimicrobial nasal washes in chronic rhinosinusitis

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Am J Rhinol. 2006 Jan-Feb;20(1):1-6.

Evidence-based recommendations for antimicrobial nasal washes in chronic

rhinosinusitis.

Elliott KA, Stringer SP.

Department of Otolaryngology and Communicative Sciences, University of

Mississippi Medical Center, , Mississippi 39216, USA.

BACKGROUND: Chronic rhinosinusitis (CRS) refractory to medical and surgical

therapy is a difficult problem for patients and physicians. Topical

antimicrobial nasal irrigations are commonly used for treatment with great

variation in methodology and without clear scientific support for current

treatment formulations. The purpose of this study was to develop a

scientific rationale for creating standardized recommendations for clinical

practice in the use of topical antimicrobial washes for CRS. METHODS: An

extensive review of basic science and clinical literature on the treatment

of CRS with topical antimicrobial washes was completed. Pharmacokinetics of

and organism susceptibility to appropriate topically applied antimicrobial

agents were reviewed. RESULTS: The most common organisms associated with CRS

were identified. The relevant pharmacokinetics of drugs targeted at these

organisms are presented. Susceptibility breakpoints set by the National

Committee for Clinical Laboratory Standards are identified to help establish

the most effective concentration of the identified drugs. Recommendations

for agent selection, agent concentration, length of treatment, dosing

schedule, and methods of irrigation are presented.

CONCLUSION: Antimicrobial nasal washes provide a potentially effective

treatment for the growing population of patients who remain symptomatic

after appropriate medical and surgical intervention. This study establishes

the basic principles supporting this treatment option and offers rational,

evidence-based treatment guidelines. The study has identified additional

areas that need to be investigated before prospective clinical trials can be

effectively undertaken.

PMID: 16539286

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16539286

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