On ciprofloxacin concentration in chronic rhinosinusitis

Area of Science:

• Pharmacology
• Otolaryngology
• Infectious Diseases

Background:

• Chronic rhinosinusitis (CRS) encompasses distinct subtypes: chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP).
• Understanding drug distribution in sinonasal tissues is crucial for effective CRS treatment.

Purpose of the Study:

• To compare plasma and sinonasal mucosal concentrations of ciprofloxacin administered via oral and topical nasal routes.
• To evaluate these concentrations in patients with and without nasal polyps.

Main Methods:

• Prospective, single-blind randomized clinical study.
• Patients with CRS undergoing endonasal surgery received a single preoperative dose of oral or topical ciprofloxacin (spray, gel, or drops).
• Plasma and sinonasal mucosal (inferior turbinate, middle turbinate, ethmoid, maxillary sinus) samples were analyzed using HPLC-FD.

Main Results:

• Oral ciprofloxacin demonstrated significant plasma concentrations and higher mucosal levels compared to topical routes.
• Topical ciprofloxacin formulations did not yield measurable plasma levels.
• The topical gel formulation provided the best mucosal concentrations, even in the presence of nasal polyposis.

Conclusions:

• Oral ciprofloxacin offers superior penetration into sinonasal mucosa compared to topical formulations.
• Topical nasal ciprofloxacin exhibits limited systemic absorption, suggesting localized action.
• Topical ciprofloxacin gel may be a viable option for achieving therapeutic concentrations in sinonasal tissues, irrespective of polyposis status.