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Comparison of Steroid and Itraconazole for Prevention of Recurrence in Allergic Fungal Rhinosinusitis: A Randomized
Moirangthem Rojita1, Swagatika Samal2, Pradeep Pradhan3
1Senior Resident, Department of Otorhinolaryngology, Safdarjung Hospital and Vardhman Mahavir Medical College, Delhi, India.
Introduction:
Allergic Fungal Rhinosinusitis (AFRS) is due to the continuous exposure of fungal antigens to an atopic individual. Medical treatment following the surgery is the standard protocol often practiced for the treatment of AFRS. Steroid (systemic/topical) has been considered as the standard medical treatment for the control of the disease in AFRS although most of the patients show recurrence with long term follow up. Instead, antifungals (itraconazole) can be tried to decrease the recurrence rate which acts by inhibiting the fungal growth in the postoperative period.
Aim:
In the current study, we have compared the efficacy between steroid and the itraconazole in preventing the recurrence of the disease in patients with AFRS in postoperative period.
Materials And Methods:
This prospective study was conducted in the Department of Otorhinolaryngology in a tertiary care referral hospital from October 2013 to February 2015. Total 60 patients with AFRS with nasal polyposis, diagnosed by Bent-Kuhn's criteria were included in the study. For patients of Group A (containing 30 patients), systemic steroid (oral prednisolone 30 mg OD) was continued for one month and afterwards topical steroid (nasal spray) was continued till six months after surgery. In Group B (containing 30 patients), oral itraconazole (100 mg BID) was continued for six months. Clinical and haematological parameters were compared at the end of six months.
Results:
The average pre-treatment and post treatment scores of Absolute Eosinophil Count (AEC) in the patients of Group A was 532 μg/l and 482 μg/l respectively and the corresponding values in Group B were 578 μg/L and 438 μg/L respectively at the end of six months (p=0.912). Similarly, the preoperative and postoperative serum IgE level in Group A was 886.20 IU/ml and 620 IU/ml and the respective values in Group B were 935 IU/ml and 570 IU/ml (p=0.555). Mean preoperative and postoperative mean SNOT score in Group A and Group B were 52.5 in 34.3 and respective values in Group B were 55.7 and 29.5.
Conclusion:
Itraconazole can be considered as an effective treatment alternative to the steroid for postoperative management of AFRS. Although there was no significant difference noted between two groups, patients treated with itraconazole had a better symptomatic relief and endoscopic clearance of disease.
Insights
Itraconazole offers an effective alternative to steroids for managing Allergic Fungal Rhinosinusitis (AFRS) post-surgery. While both treatments showed similar results, itraconazole provided better symptom relief and disease clearance in patients with AFRS.
Area of Science:
- Otorhinolaryngology
- Immunology
- Pharmacology
Background:
- Allergic Fungal Rhinosinusitis (AFRS) arises from fungal antigen exposure in atopic individuals.
- Post-surgical medical treatment is standard for AFRS, with steroids being the typical choice.
- Steroid treatment often leads to disease recurrence in AFRS patients with long-term follow-up.
Purpose of the Study:
- To compare the efficacy of steroids versus itraconazole in preventing AFRS recurrence.
- To evaluate the effectiveness of antifungals as an alternative to steroids in postoperative AFRS management.
Main Methods:
- A prospective study involving 60 AFRS patients diagnosed via Bent-Kuhn's criteria.
- Group A received systemic and topical steroids; Group B received oral itraconazole for six months post-surgery.
- Clinical and hematological parameters were compared after six months.
Main Results:
- Both groups showed reductions in Absolute Eosinophil Count (AEC) and serum IgE levels.
- Mean SNOT scores improved significantly in both groups, with Group B (itraconazole) showing slightly better outcomes.
- No statistically significant difference was observed between the groups for AEC and IgE levels (p=0.912 and p=0.555, respectively).
Conclusions:
- Itraconazole is a viable alternative to steroids for postoperative AFRS management.
- Patients treated with itraconazole experienced superior symptomatic relief and endoscopic disease clearance.
- Further research may explore itraconazole's role in reducing AFRS recurrence rates.
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