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Antifungal therapy in the treatment of chronic rhinosinusitis: a meta-analysis
Peta-Lee Sacks1, Richard J Harvey, Janet Rimmer
1St. Vincent's Clinical School, St. Vincent's Hospital, University of New South Wales, New South Wales, Sydney, Australia. richard@sydneyentclinic.com
Background:
Chronic rhinosinusitis (CRS) is an inflammatory disorder of the nose and sinuses. Because fungi were postulated as a potential cause of CRS in the late 1990s, contrasting articles have advocated and refuted the use of antifungal agents in its management. Although good research shows an interaction of the immune system with fungus in CRS, e.g., allergic fungal sinusitis (AFS), this does not imply that fungi are the cause of CRS or that antifungals will be effective in management. This study was designed to assess the potential advantage of either topical or systemic antifungal therapy in the symptomatic treatment of CRS to aid physicians in making informed decisions about treating patients with CRS.
Methods:
A systematic review of the literature was performed with meta-analysis. All studies obtained from searches were reviewed and trials meeting the eligibility criteria were selected. CRS was defined using either the European Position Paper on Rhinosinusitis and Nasal Polyps or American Academy of Otolaryngology-Head and Neck Surgery criteria. Authors were contacted and original data were used for data analysis.
Results:
Five studies investigating topical antifungals and one investigating systemic antifungals met the inclusion criteria. All trials were double blinded and randomized. Pooled meta-analysis showed no statistically significant benefit of topical or systemic antifungals over placebo. Symptoms scores statistically favored the placebo group for this outcome. Adverse event reporting was higher in the antifungal group.
Conclusion:
Reported side-effects of antifungal therapies may outweigh any potential benefits of treatment based on this meta-analysis and the authors therefore do not advocate the use antifungal treatment in the management of CRS.
Insights
Antifungal treatments for chronic rhinosinusitis (CRS) showed no significant benefit over placebo. Side effects were more common with antifungals, leading to a recommendation against their use in CRS management.
Area of Science:
- Otolaryngology
- Immunology
- Pharmacology
Background:
- Chronic rhinosinusitis (CRS) is a nasal and sinus inflammatory condition.
- Fungal involvement in CRS has been debated since the late 1990s.
- Allergic fungal sinusitis (AFS) demonstrates immune interaction with fungi, but causality in CRS is unproven.
Purpose of the Study:
- To evaluate the efficacy of topical and systemic antifungal therapy for symptomatic CRS treatment.
- To provide evidence-based guidance for physicians managing CRS patients.
Main Methods:
- Systematic literature review and meta-analysis.
- Included studies defined CRS using established European or American criteria.
- Original data were obtained from authors for analysis.
Main Results:
- Five studies on topical and one on systemic antifungals met inclusion criteria.
- All included trials were double-blinded and randomized.
- Meta-analysis revealed no statistically significant benefit of antifungals over placebo; placebo groups showed better symptom scores. Adverse events were higher in the antifungal group.
Conclusions:
- Potential benefits of antifungal therapy for CRS do not outweigh reported side effects.
- The authors do not recommend antifungal treatment for managing chronic rhinosinusitis based on this meta-analysis.
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