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Biofilms in chronic rhinosinusitis with polyps: is eradication possible?
Hakan Korkmaz1, Bülent Ocal, Emel Cadallı Tatar
1Department of Otolaryngology, Yıldırım Beyazıt University Medical School, Ankara, Turkey.
Summary
Adding long-term oral clarithromycin to mometasone furoate nasal spray effectively eradicated biofilms in chronic rhinosinusitis patients. However, combined therapy showed no significant improvement in CT scans or symptom scores compared to nasal spray alone.
Area of Science:
- Otolaryngology
- Microbiology
- Pharmacology
Background:
- Chronic rhinosinusitis with polyps (CRSwP) often involves persistent mucosal biofilms.
- Biofilm eradication is a key goal in CRSwP management.
- Current treatments may not fully address biofilm presence.
Purpose of the Study:
- To investigate the efficacy of mometasone furoate nasal spray monotherapy versus combination therapy with oral clarithromycin in treating biofilms in CRSwP.
- To assess the impact of these treatments on sinonasal mucosal biofilms, computerized tomography (CT) scores, and symptom severity.
Main Methods:
- A randomized controlled trial involving 34 CRSwP patients.
- Group 1: Mometasone furoate nasal spray (200 μg daily for 8 weeks).
- Group 2: Oral clarithromycin (500 mg twice daily for 2 weeks, then 250 mg daily for 6 weeks) plus mometasone furoate nasal spray.
- Primary outcome: Biofilm detection via scanning electron microscopy. Secondary outcomes: CT scores and Sinonasal Outcome Test-20 (SNOT-20).
Main Results:
- Mucosal biofilms were present in 68% of patients pretreatment.
- Biofilm eradication occurred in 1 of 11 patients (monotherapy) versus 6 of 12 patients (combination therapy).
- Significant improvement in CT and SNOT-20 scores was observed in both groups, with no statistically significant difference between them.
Conclusions:
- Long-term, low-dose oral clarithromycin combined with mometasone furoate nasal spray demonstrated effectiveness in eradicating sinonasal biofilms in CRSwP patients.
- While biofilm eradication was higher with combination therapy, it did not lead to superior improvements in radiological or symptomatic outcomes compared to nasal steroid monotherapy.
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