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The role of itraconazole in recalcitrant fungal sinusitis

Kristin Seiberling1, Peter-John Wormald

  • 1Department of Surgery-Otolaryngology, University of Adelaide, South Australia, Australia.

American Journal of Rhinology & Allergy
|June 4, 2009
PubMed
Abstract

Insights

Oral itraconazole shows promise for treating allergic fungal sinusitis (AFS) in patients refractory to other treatments. This antifungal medication may reduce symptoms, decrease oral steroid dependence, and prolong remission periods.

Area of Science:

  • Otolaryngology
  • Mycology
  • Pharmacology

Background:

  • Allergic fungal sinusitis (AFS) shares similarities with allergic bronchopulmonary aspergillosis (ABPA).
  • Oral itraconazole is an established antifungal treatment for ABPA.
  • This study investigates itraconazole's efficacy in refractory AFS cases.

Purpose of the Study:

  • To evaluate the therapeutic response of oral itraconazole in patients with chronic fungal sinusitis.
  • To assess itraconazole's impact on symptom recurrence and oral steroid use in AFS patients.

Main Methods:

  • Retrospective chart review of 23 patients with AFS treated with oral itraconazole.
  • Data collected included demographics, comorbidities, allergies, fungal cultures, surgical history, and steroid use.
  • Patients received a 6-month course of itraconazole (100 mg b.i.d.) for recurrent disease post-surgery.

Main Results:

  • Nineteen of 23 patients responded to itraconazole, showing reduced symptoms and fungal debris.
  • Three patients discontinued treatment due to elevated liver enzymes.
  • Of 16 patients with decreased steroid use, 11 achieved disease remission at a mean follow-up of 15.7 months.

Conclusions:

  • Oral itraconazole may benefit patients with recalcitrant fungal sinusitis unresponsive to maximal therapy.
  • Itraconazole can potentially extend time to recurrence and reduce or eliminate the need for oral steroids.
  • No permanent complications were observed from itraconazole treatment.

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