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Tratamientos médicos para la sinusitis crónica en adultos: una revisión sistemática
Luke Rudmik1, Zachary M Soler2
1Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta.
JAMA
|September 2, 2015
Resumen
El riego diario con solución salina y los corticosteroides tópicos son tratamientos efectivos de primera línea para la sinusitis crónica. Se pueden considerar otras terapias como los corticosteroides sistémicos o los antibióticos para grupos específicos de pacientes, especialmente aquellos con pólipos nasales.
Área de la Ciencia:
- Otorrinolaringología
- Alergia e inmunología
- Farmacología
Sus antecedentes:
- La sinusitis crónica es una condición inflamatoria prevalente que afecta durante más de 3 meses, afectando la calidad de vida y incurriendo en costos de atención médica significativos.
- El manejo médico eficaz es crucial para optimizar los resultados de los pacientes y prevenir las exacerbaciones.
Objetivo del estudio:
- Revisar sistemáticamente la evidencia de la más alta calidad sobre las terapias médicas para la sinusitis crónica en adultos.
- Proporcionar un enfoque basado en la evidencia para optimizar la atención al paciente en el manejo de la sinusitis crónica.
Principales métodos:
- Se realizó una revisión sistemática de ensayos clínicos aleatorizados (ECA), revisiones sistemáticas y metanálisis.
- Se realizaron búsquedas en las bases de datos Ovid MEDLINE, EMBASE y Cochrane.
- La evidencia se clasificó en función del mantenimiento frente a las terapias intermitentes/de rescate y la presencia o ausencia de pólipos nasales.
Principales resultados:
- La irrigación diaria con solución salina demostró una mejora significativa de los síntomas en comparación con la ausencia de tratamiento.
- Los corticosteroides tópicos mejoraron los síntomas generales, redujeron el tamaño de los pólipos y disminuyeron la recurrencia de pólipos después de la cirugía.
- Los corticosteroides sistémicos, la doxiciclina y los antagonistas de los leucotrienos mostraron beneficios en pacientes con pólipos nasales, mientras que los macrólidos mejoraron la calidad de vida en aquellos sin pólipos.
Conclusiones:
- Se recomienda la irrigación salina de alto volumen combinada con tratamiento tópico con corticosteroides como tratamiento de primera línea para la sinusitis crónica.
- Los ciclos cortos de corticosteroides sistémicos, doxiciclina o antagonistas de leucotrienos son opciones para los pacientes con pólipos nasales.
- En pacientes con sinusitis crónica sin pólipos nasales puede considerarse un tratamiento prolongado con antibióticos macrólidos.
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