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COMPARISON OF CEFUROXIME WITH OR WITHOUT INTRANASAL FLUTICASONE FOR THE TREATMENT OF RHINOSINUSITIS

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Infectious Diseases in Clinical Practice: January 2002 - Volume 11 - Issue 1 - p 39-40
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COMPARISON OF CEFUROXIME WITH OR WITHOUT INTRANASAL FLUTICASONE FOR THE TREATMENT OF RHINOSINUSITIS

[Dolor RJ et al. JAMA 2001;286:3097]:

This is a report by the “Ceftin and Flonase for Sinusitis Investigators” to determine the efficacy of fluticasone (Flonase) in the treatment of acute sinusitis. Criteria for inclusion were acute sinusitis as verified by a Watersview x-ray or endoscopy showing pus from the middle meatus or sinus ostium plus at least two of the criteria of the American Academy of Otolaryngology: headache, face pain, nasal congestion, and olfactory disturbance (Otolaryngol Head Neck Surg 1997;117:S8). All patients had a history of recurrent sinusitis or chronic sinusitis. The method of study was a double-blind, randomized, placebo-controlled trial in which all participants received cefuroxime axetil for 10 days plus a nasal decongestant (xylometazoline) twice daily for 3 days. The results show that all participants responded, but the recipients of Flonase responded faster with a median time to significant improvement of 6 days vs. 9.5 days in the placebo group (p = 0.01). The authors conclude that Flonase combined with antibiotics and a nasal decongestant accelerates recovery from acute sinusitis in patients with a history of chronic or recurrent sinusitis.

Comment.

The role of topical steroids has been controversial, but most have recommended this approach to therapy in those with an allergic basis of sinusitis symptoms. The recent guidelines from the CDC and from the American College of Physicians have not endorsed nasal steroids, primarily on the basis of lack of data to support this intervention. These guidelines also failed to endorse the use of antibiotics for acute sinusitis unless symptoms are severe or last for at least 7–10 days, which would be the time required for resolution for most uncomplicated URIs. This trial used the sponsor’s antibiotic (Ceftin) in all participants so that no comment or conclusion could be made regarding efficacy of this or any other antibiotic. The trial does seem to support the use of topical nasal steroids, but in a subset of patients with recurrent or chronic sinusitis.

© 2002 Lippincott Williams & Wilkins, Inc.