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Mardikasari SA, Katona G, Sipos B, Csóka I. Essential considerations towards development of effective nasal antibiotic formulation: features, strategies, and future directions. Expert Opin Drug Deliv 2024; 21:611-625. [PMID: 38588551 DOI: 10.1080/17425247.2024.2341184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 04/05/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Intranasal antibiotic products are gaining popularity as a promising method of administering antibiotics, which provide numerous benefits, e.g. enhancing drug bioavailability, reducing adverse effects, and potentially minimizing resistance threats. However, some issues related to the antibiotic substances and nasal route challenges must be addressed to prepare effective formulations. AREAS COVERED This review focuses on the valuable points of nasal delivery as an alternative route for administering antibiotics, coupled with the challenges in the nasal cavity that might affect the formulations. Moreover, this review also highlights the application of nasal delivery to introduce antibiotics for local therapy, brain targeting, and systemic effects that have been conducted. In addition, this viewpoint provides strategies to maintain antibiotic stability and several crucial aspects to be considered for enabling effective nasal formulation. EXPERT OPINION In-depth knowledge and understanding regarding various key considerations with respect to the antibiotic substances and nasal route delivery requirement in preparing effective nasal antibiotic formulation would greatly improve the development of nasally administered antibiotic products, enabling better therapeutic outcomes of antibiotic treatment and establishing appropriate use of antibiotics, which in turn might reduce the chance of antibiotic resistance and enhance patient comfort.
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Affiliation(s)
- Sandra Aulia Mardikasari
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
- Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Gábor Katona
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Bence Sipos
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Ildikó Csóka
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
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Mardikasari SA, Sipos B, Csóka I, Katona G. Nasal route for antibiotics delivery: Advances, challenges and future opportunities applying the quality by design concepts. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Matuszak M, Ochowiak M, Włodarczak S, Krupińska A, Doligalski M. State-of-the-Art Review of The Application and Development of Various Methods of Aerosol Therapy. Int J Pharm 2021; 614:121432. [PMID: 34971755 DOI: 10.1016/j.ijpharm.2021.121432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/09/2021] [Accepted: 12/23/2021] [Indexed: 12/23/2022]
Abstract
Aerosol therapy is a rapidly developing field of science. Due to a number of advantages, the administration of drugs to the body with the use of aerosol therapy is becoming more and more popular. Spraying drugs into the patient's lungs has a significant advantage over other methods of administering drugs to the body, including injection and oral methods. In order to conduct proper and effective aerosol therapy, it is necessary to become familiar with the basic principles and applications of aerosol therapy under various conditions. The effectiveness of inhalation depends on many factors, but most of all on: the physicochemical properties of the sprayed system, the design of the medical inhaler and its correct application, the dynamics of inhalation (i.e. the frequency of breathing and the volume of inhaled air). It is worth emphasizing that respiratory system diseases are one of the most frequently occurring and fastest growing diseases in the world. Accordingly, in recent years, a significant increase in the number of new spraying devices and pharmaceutical drugs for spraying has appeared on the market. It should also be remembered that the process of spraying a liquid is a complicated and complex process, and its efficiency is very often characterized by the use of micro- and macro parameters (including average droplet diameters or the spectrum of droplet diameter distribution). In order to determine the effectiveness of the atomization process and in the delivery of drugs to the patient's respiratory tract, the analysis of the size of the generated aerosol droplets is most often performed. Based on the proposed literature review, it has been shown that many papers dealt with the issues related to aerosol therapy, the selection of an appropriate spraying device, the possibility of modifying the spraying devices in order to increase the effectiveness of inhalation, and the possibility of occurrence of certain discrepancies resulting from the use of various measurement methods to determine the characteristics of the generated aerosol. The literature review presented in the paper was prepared in order to better understand the spraying process. Moreover, it can be helpful in choosing the right medical inhaler for a given liquid with specific rheological properties. The experimental data contained in this study are of great cognitive importance and may be of interest to entities involved in pharmaceutical product engineering (in particular in the case of the production of drugs containing liquids with complex rheological properties).
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Affiliation(s)
- M Matuszak
- Faculty of Chemical Technology, Poznan University of Technology, Institute of Chemical Technology and Engineering, 4 Berdychowo Street, 60-965 Poznan, Poland.
| | - M Ochowiak
- Faculty of Chemical Technology, Poznan University of Technology, Institute of Chemical Technology and Engineering, 4 Berdychowo Street, 60-965 Poznan, Poland
| | - S Włodarczak
- Faculty of Chemical Technology, Poznan University of Technology, Institute of Chemical Technology and Engineering, 4 Berdychowo Street, 60-965 Poznan, Poland
| | - A Krupińska
- Faculty of Chemical Technology, Poznan University of Technology, Institute of Chemical Technology and Engineering, 4 Berdychowo Street, 60-965 Poznan, Poland
| | - M Doligalski
- Faculty of Computer, Electrical and Control Engineering, University of Zielona Góra, 4a Szafrana Street, 65-516 Zielona Góra, Poland
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4
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Hyo Y, Fujieda S, Matsubara A, Takeuchi K, Ohki M, Shimizu T, Kurono Y. Survey of nebulizer therapy for nasal inflammatory diseases in Japan before and during the COVID-19 pandemic. Auris Nasus Larynx 2021; 49:504-510. [PMID: 34865941 PMCID: PMC8606268 DOI: 10.1016/j.anl.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/06/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
Objective: Nebulizer therapy is an effective and safe topical treatment for rhinosinusitis and is frequently used by otolaryngologists in Japan. However, treatment methods used vary among regions and according to doctors’ preferences. In this study, we aimed to investigate the use of nebulizer therapy for rhinosinusitis. Administration of nebulizer therapy has been affected by the coronavirus disease 2019 (COVID-19) pandemic. Thus, we also investigated the difference in the prevalence of nebulizer use before and during the pandemic. Methods: Between February and September 2016 and in January 2021, we administered questionnaire surveys on nebulizer treatment for rhinosinusitis to otorhinolaryngologists, who were members of the Oto-Rhino-Laryngological Society of Japan, in Aomori, Saitama, Mie, Fukui, Shiga, Okayama, and Kagoshima prefectures. Results: More than 90% of the otorhinolaryngologists performed nebulizer treatment for rhinosinusitis in 2016. In April 2020 (the first wave of the COVID-19 pandemic), the use rate decreased to 20%, but in January 2021, the use rate increased to 60%. Jet nebulizers were the most frequently used type. One-third of the otolaryngologists enlarged the natural opening of the paranasal sinuses in more than half of their patients by using vasoconstrictors. Cefmenoxime and betamethasone were the most commonly used antibiotics and steroids, respectively. Conclusion: Because it is important to perform nasal pretreatment and strict disinfection of nebulizer equipment, it is clear that education of otorhinolaryngologists as well as paramedical personnel is required to ensure safe and effective use of nebulizer therapy in Japan.
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Affiliation(s)
- Yukiyoshi Hyo
- Department of Otolaryngology - Head and Neck Surgery, Kawasaki Medical School, Kurashiki, Japan; HYO ENT Clinic, Kyoto, Japan.
| | - Shigeharu Fujieda
- Division of Otorhinolaryngology - Head & Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | | | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology - Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Motofumi Ohki
- Department of Otolaryngology, Kitasato University Medical center, Saitama, Japan
| | - Takeshi Shimizu
- Department of Otorhinolaryngology, Shiga University of Medical Science, Ootsu, Japan
| | - Yuichi Kurono
- Department of Otolaryngology - Head & Neck Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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5
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 357] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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Ohki M, Hyo Y, Yoshiyama Y, Takano H, Takahata J, Suzuki M, Takeno S, Ogoshi T, Suzuki K, Takeuchi K, Naito K, Haruna S, Fujisawa T, Yamaguchi S, Hotomi M, Kawauchi H, Kurono Y. Consensus guidance of nebulizer therapy for acute rhinosinusitis. Auris Nasus Larynx 2019; 47:18-24. [PMID: 31477344 DOI: 10.1016/j.anl.2019.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/30/2019] [Accepted: 08/15/2019] [Indexed: 11/16/2022]
Abstract
The guidance deals with the recommended applications, procedures, and safety management of nebulizer therapy for acute rhinosinusitis. In Japan, nebulizer therapy for sinusitis has been covered by public health insurance since 1958 and has been commonly carried out nationwide. The Japan Society for Infection and Aerosol in Otorhinolaryngology and the Oto-Rhino-Laryngological Society of Japan set up a working group to draw up a consensus guidance on nebulizer therapy for acute rhinosinusitis. The device for nebulizer therapy are classified into jet, ultrasound, and mesh types. In Japan, cefmenoxime hydrochloride (CMX) was approved for use in nebulizer therapy since 1996. The widening of the obstructed lesions such as large polyps prior to nebulizer therapy were recommended. The numbers of times of nebulizer therapy is recommended for three times in a week for at least for 2 weeks (cure rate: 68%, eradication ratio: 48%). Concerns should be pay for the changes of activity of medicine due to the mixing and bacterial contamination. Pseudomonas cepacia growing in a short even in both saline and distilled water leads to contamination at high concentrations by 2 days. Nebulizer therapy is an effective treatment based on a drug delivery system (DDS) to the nasal and paranasal cavities. The therapy effectively increases the local drug concentration by promptly and uniformly delivering drugs to a targeted local site. The therapy is safe with less systemic absorption and with few adverse reactions.
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Affiliation(s)
- Motofumi Ohki
- Department of Otorhinolaryngology, Kitasato University Medical Center, Saitama, Japan
| | - Yukiyoshi Hyo
- Department of Otolaryngology, Kawasaki Medical School, Kurashiki, Japan.
| | | | - Hiroshi Takano
- Bio-microfluidics Science Research Center, Doshisha University, Kyoto, Japan
| | - Junko Takahata
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Motohiko Suzuki
- Department of Otorhinolaryngology, Nagoya City University, Nagoya, Japan
| | - Sachio Takeno
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | | | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kensei Naito
- Principal of Academy of Nursing, Fujita Health University, Toyoake, Japan
| | - Shinichi Haruna
- Department of Otorhinolaryngology, Dokkyo Medical University, Tochigi, Japan
| | | | - Sota Yamaguchi
- Department of Otorhinolaryngology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Muneki Hotomi
- Department of Otorhinolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hideyuki Kawauchi
- Department of Otorhinolaryngology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Yuichi Kurono
- Department of Otolaryngology, Faculty of Medicine, Kagoshima University, Japan
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Velepič M, Manestar D, Perković I, Škalamera D, Braut T. Inhalation Aerosol Therapy in the Treatment of Chronic Rhinosinusitis: A Prospective Randomized Study. J Clin Pharmacol 2019; 59:1648-1655. [DOI: 10.1002/jcph.1471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 05/31/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Marko Velepič
- Clinic of Otorhinolaryngology Head and Neck SurgeryClinical Medical Centre, University of Rijeka Rijeka Croatia
| | | | - Ivona Perković
- Clinic of Otorhinolaryngology Head and Neck SurgeryClinical Medical Centre, University of Rijeka Rijeka Croatia
| | - Dunja Škalamera
- Clinic of Otorhinolaryngology Head and Neck SurgeryClinical Medical Centre, University of Rijeka Rijeka Croatia
| | - Tamara Braut
- Clinic of Otorhinolaryngology Head and Neck SurgeryClinical Medical Centre, University of Rijeka Rijeka Croatia
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Snidvongs K, Thanaviratananich S. Update on Intranasal Medications in Rhinosinusitis. Curr Allergy Asthma Rep 2017; 17:47. [PMID: 28602009 DOI: 10.1007/s11882-017-0720-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This review describes beneficial effects and adverse events of various intranasal medications in treating rhinosinusitis. Application of intranasal steroids has been described in treating all subtypes of adult rhinosinusitis, but reports are limited in pediatrics and mostly in acute pediatric subgroups resulted in benefits While saline irrigation is effective for patients with chronic rhinosinusitis without polyps and in pediatric acute rhinosinusitis, there is no evidence yet for saline drips and sprays. Application of intranasal antifungals and nasal irrigation with surfactant brings more harm than benefits. There is no evidence supporting the use of intranasal antibiotics. We also review influence of devices, methods, and patient head position on nasal and paranasal sinus drug delivery.
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Affiliation(s)
- Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 Suppl 1:S22-209. [DOI: 10.1002/alr.21695] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital; London UK
| | - Amber Luong
- University of Texas Medical School at Houston
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Prulière-Escabasse V, Michel J, Percodani J, Serrano E, Gilain L, Crampette L, Jankowski R, Stoll D, de Gabory L. Consensus document for prescription of nebulization in rhinology. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:371-374. [DOI: 10.1016/j.anorl.2014.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
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11
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Wei CC, Adappa ND, Cohen NA. Use of topical nasal therapies in the management of Chronic rhinosinusitis. Laryngoscope 2013; 123:2347-59. [DOI: 10.1002/lary.24066] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 01/10/2013] [Accepted: 01/31/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Calvin C. Wei
- Department of Otolaryngology-Head and Neck Surgery; St. Luke's-Roosevelt Hospital; New York; New York
| | - Nithin D. Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Pennsylvania School of Medicine; Hospital of the University of Pennsylvania; Philadelphia; Pennsylvania; U.S.A
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13
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Rudmik L, Hoy M, Schlosser RJ, Harvey RJ, Welch KC, Lund V, Smith TL. Topical therapies in the management of chronic rhinosinusitis: an evidence-based review with recommendations. Int Forum Allergy Rhinol 2012; 3:281-98. [PMID: 23044832 DOI: 10.1002/alr.21096] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/27/2012] [Accepted: 07/21/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Topical therapies have become an integral component in the management plan for chronic rhinosinusitis (CRS). Several topical therapy strategies have been evaluated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the utilization of topical therapies in the management of CRS. METHODS A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; and clearly defined primary clinical end-point. We focused on reporting higher-quality studies (level 2b or higher), but reported on lower-level studies if the topic contained insufficient evidence. We excluded drug-eluting spacer and stent therapy from this review. RESULTS This review identified and evaluated the literature on 5 topical therapy strategies for CRS: saline irrigation, topical steroid, topical antibiotic, topical antifungal, and topical alternatives (surfactant, manuka honey, and xylitol irrigations). CONCLUSION Based on the available evidence, sinonasal saline irrigation and standard topical nasal steroid therapy are recommended in the topical treatment of CRS. Nonstandard (off-label) topical sinonasal steroid therapies can be an option for managing CRS. The evidence recommends against the use of topical antifungal therapy and topical antibiotic therapy delivered using nebulized and spray techniques in routine cases of CRS. There is insufficient clinical research to provide recommendations for alternative therapies or topical antibiotic therapy delivered using other delivery methods (eg, irrigations).
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Affiliation(s)
- Luke Rudmik
- Endoscopic Sinus and Skull Base Surgery, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta T2N 2T9, Canada.
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Soler ZM, Oyer SL, Kern RC, Senior BA, Kountakis SE, Marple BF, Smith TL. Antimicrobials and chronic rhinosinusitis with or without polyposis in adults: an evidenced-based review with recommendations. Int Forum Allergy Rhinol 2012; 3:31-47. [PMID: 22736403 DOI: 10.1002/alr.21064] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 04/09/2012] [Accepted: 04/17/2012] [Indexed: 01/30/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is characterized by inflammation of the mucosa of the nose and paranasal sinuses. The role of bacterial or fungal infection in CRS is unclear, yet antimicrobials are commonly prescribed for this condition. Published guidelines offer little direction regarding antibiotic strategies for CRS. The purpose of this article is to provide an evidence-based approach to the use of antibacterial and antifungal antibiotics in the management of CRS. METHODS A systematic review of the literature was performed following recommendations of the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE). Inclusion criteria were: age ≥18 years old, chronic rhinosinusitis with or without polyps, antibiotic treatment as the experimental group, and clearly defined primary clinical endpoint. Studies involving patients with cystic fibrosis or acute invasive fungal sinusitis were excluded. RESULTS The review identified and evaluated the literature on 8 classes of antimicrobials for CRS: oral antibacterial antibiotics ≤3 weeks, oral antibacterial antibiotics >3 weeks, macrolide antibiotics, intravenous antibacterial antibiotics, topical antibacterial antibiotics, oral antifungals, intravenous antifungals, and topical antifungals. CONCLUSION Based on the available evidence, oral antibacterial antibiotics and prolonged macrolide antibiotics are considered therapeutic options in the treatment of CRS while the use of topical antibacterial antibiotics, intravenous antibacterial antibiotics and oral, topical, or intravenous antifungals would be recommended against. These evidence-based recommendations should not necessarily be applied to all patients with CRS and are not intended to supersede clinical judgment based on individual patient circumstances.
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Affiliation(s)
- Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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15
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Albu S. Novel drug-delivery systems for patients with chronic rhinosinusitis. DRUG DESIGN DEVELOPMENT AND THERAPY 2012; 6:125-32. [PMID: 22745531 PMCID: PMC3383347 DOI: 10.2147/dddt.s25199] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chronic rhinosinusitis, one of the most common chronic medical complaints in the United States, seems to be increasing in incidence and prevalence, and has a significant impact on quality of life. Topical forms of medical therapy represent an attractive alternative for drug delivery to the nasal cavity and paranasal sinuses. Topical drug delivery has the advantage of directly acting on the site of inflammation, producing a higher concentration at the target site while avoiding systemic side effects. Although considerable research has been undertaken into improving nasal formulations in order to enhance absorption, little attention has so far been directed to upgrading the delivery devices. The aim of this review is to present current knowledge on the novel drug-delivery devices in use in the management of chronic rhinosinusitis patients, and to present the current available knowledge on topical drug penetration into the sinuses using various delivery devices. Additionally, methods used to enhance fluid sinus deposition are presented and the published clinical studies on the results of nebulized antibiotics in the treatment of chronic rhinosinusitis patients are discussed.
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Affiliation(s)
- Silviu Albu
- Department of Otolaryngology, University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.
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Abstract
Antimicrobial therapy has been a mainstay of treatment for chronic rhinosinusitis (CRS). The roles of bacterial and fungal infection in the primary pathogenesis of CRS recently have been called into question. Although many different bacteria and fungi can be isolated from CRS patients, antimicrobial treatment directed at their eradication has met with mixed clinical results. Overall, macrolide antibiotics hold the most promise before surgery. Topical antibiotics are safe, efficient, and effective for treating acute bacterial exacerbations of CRS after endoscopic sinus surgery and may prevent the development of subsequent bacterial resistance. Topical treatment of CRS with antifungal agents both before and after sinus surgery is of limited benefit and should not be considered as a primary treatment modality before surgery. Further research into the role of bacterial and fungal infection in the pathophysiology of CRS may offer better insights into appropriate antimicrobial choices, dosing, and treatment duration.
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Affiliation(s)
- Neil Bhattacharyya
- Harvard Medical School, Division of Otolaryngology, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115, USA.
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Lim M, Citardi MJ, Leong JL. Topical antimicrobials in the management of chronic rhinosinusitis: a systematic review. AMERICAN JOURNAL OF RHINOLOGY 2008; 22:381-389. [PMID: 18702902 DOI: 10.2500/ajr.2008.22.3189] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a common disease that can significantly impact health. The mainstay of medical treatment is topical steroids and oral antibiotics, but little is known about the efficacy of topical antibiotics. The purpose of this study was to identify evidence for the use of topical antibiotics in the treatment of CRS and exacerbations of CRS. METHODS Systematic review of literature with a search of the MEDLINE, EMBASE, and CINAHL databases; Cochrane Central Register of Controlled Trials (Third Quarter 2007); and Cochrane Database of Systemic Reviews (3rd Quarter 2007) databases were performed. The dates of search were from December 1, 1949 to September 30, 2007. RESULTS Fourteen studies that fulfilled the inclusion criteria were identified: seven were controlled trials and of these, five were double blinded and randomized. Only one of the randomized studies showed a positive outcome. Overall, there was low-level corroborative evidence for the use of antibacterials. No definite conclusions could be made regarding the use of antifungals. Currently, there is evidence for the use of nasal irrigation or nebulization rather than delivery by nasal spray. For the antibacterial studies, the highest level of evidence currently exists for studies that have used postsurgical patients and culture-directed therapy. Both stable and acute exacerbations of CRS appear to benefit from topical antimicrobials. CONCLUSION Topical antibiotics appear effective in the management of CRS. Given the combination of low-level evidence (level III, with inherent potential confounders of natural progression of disease and placebo effect) and the level IIb evidence being limited to the cystic fibrosis group of patients, topical antibiotics should not be first-line management but may be attempted in patients refractory to the traditional topical steroids and oral antibiotics. Larger and better-designed randomized double-blind placebo-controlled trials are required to more fully evaluate this emerging modality of treatment.
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Affiliation(s)
- Mingyann Lim
- Department of Otolaryngology, Singapore General Hospital, Singapore
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Falagas ME, Giannopoulou KP, Kokolakis GN, Rafailidis PI. Fosfomycin: Use Beyond Urinary Tract and Gastrointestinal Infections. Clin Infect Dis 2008; 46:1069-77. [PMID: 18444827 DOI: 10.1086/527442] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Naghdi S, Ansari NN, Farhadi M. A Clinical Trial on the Treatment of Chronic Rhinosinusitis with Continuous Ultrasound. J Phys Ther Sci 2008. [DOI: 10.1589/jpts.20.233] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Soofia Naghdi
- Faculty of Rehabilitation, Tehran University of Medical Sciences
| | | | - Mohammad Farhadi
- Research Center of Ear, Nose and Throat, Iran University of Medical Sciences
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Affiliation(s)
- Glenis K Scadding
- Royal National Throat, Nose and Ear Hospital, Grays Inn Road, London WC1X 8DA, UK.
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Mikuniya T, Nagai S, Takeuchi M, Izumi T. Differential effects of fosfomycin and corticosteroid on the molar ratio of interleukin-1 receptor antagonist/interleukin-1β in the culture supernatants of mononuclear phagocytes from patients with sarcoidosis. J Infect Chemother 2004; 10:293-8. [PMID: 16163465 DOI: 10.1007/s10156-004-0335-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2004] [Accepted: 07/05/2004] [Indexed: 10/26/2022]
Abstract
We compared the effects of fosfomycin, an antibiotic reported to possess immunomodulatory activities, and prednisolone on the production of interleukin-1 receptor antagonist (IL-1ra) and IL-1beta by bronchoalveolar lavage fluid (BALF) macrophages obtained from sarcoidosis patients. The molar IL-1ra/IL-1beta ratio in the culture supernatants of BALF macrophages obtained from sarcoidosis patients, which was lower in sarcoidosis patients than in healthy nonsmokers, was significantly increased in the presence of fosfomycin, but decreased by prednisolone. Further, the molar IL-1ra/IL-1beta ratios in the culture supernatants of peripheral blood mononuclear cells isolated from four of five patients after fosfomycin administration for 14 days were higher than the ratios measured before fosfomycin administration. Fosfomycin showed an anti-inflammatory effect in a different way, when compared with that of prednisolone.
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Affiliation(s)
- Takeshi Mikuniya
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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