colistin and Sinusitis

Despite optimal medical therapy and endoscopic sinus surgery there still remains a group of unfortunate patients suffering from exacerbations of recalcitrant chronic sinusitis. We have performed a pilot study in order to determine whether nebulized topical antibiotic therapy improves sinusitis symptoms more than saline-based placebo in patients with recalcitrant chronic rhinosinusitis.. A randomized, placebo-controlled, double-blind, cross-over pilot study was conducted in 14 patients with recalcitrant CRS. Nasal irrigation with bacitracin/colimycin or placebo using the RhinoFlow nebulizer twice daily was administered in combination with oral levofloxacin. Severity of a diversity of symptoms was measured using the VAS score, a Disease-Specific Symptom Score and the SF-36 questionnaire. Nasal endoscopic findings were also assessed.. For most VAS items and Disease-Specific Symptom Scores, a reduction in severity of symptoms was noted in both the bacitracin/colimycin and the placebo group. No significant difference was found between the 2 arms (bacitracin/colimycin vs. placebo). Most SF-36 items improved, compared with the situation before treatment in both groups. However no significant difference was found between the verum and placebo arm. Endoscopic findings did not reveal significant differences when comparing the 2 treatments.. The outcome of this study suggests a beneficial effect of nebulizing the nose with saline. This study again shows that adding antibiotics to local saline is not effective. Although the placebo-controlled studies looking at the effect of local antibiotics are all small they all point to the same direction: no effect. Definite conclusions however need a large randomized, multicenter study.

Topics: Administration, Inhalation; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacitracin; Chronic Disease; Colistin; Cross-Over Studies; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Levofloxacin; Male; Middle Aged; Nebulizers and Vaporizers; Ofloxacin; Pilot Projects; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus

Most patients with cystic fibrosis (CF) have chronic rhinosinusitis; their sinuses are often colonized with bacteria that can initiate and maintain deleterious pulmonary infections. Theoretically, eradication of the sinus bacteria should reduce the frequency of lung infections and thereby reduce pulmonary morbidity. This article addressed whether bacteria in CF sinuses are eligible for eradication by sinus surgery and postoperative treatment.. A prospective study including 58 CF patients, who had extensive sinus surgery and growth of Pseudomonas aeruginosa, Achromobacter xylosoxidans, and/or Burkholderia multivorans in their sinuses, was initiated. All patients followed a systematic postoperative treatment program of nasal irrigations with saline and colistimethate sodium and systematic endoscopic cleansing. All patients had follow-up examinations including sinus cultures; each side of the nose was cultured separately.. At the 6-month follow-up visit, 49 patients were cultured; 66 of 98 maxillary-ethmoidal complexes (67%) showed no growth of pathogenic bacteria. Some patients were not free from CF pathogenic bacteria at all cultures; however, 20 (41%) patients had no bilateral regrowth (p < 0.01) and 4 patients had no unilateral regrowth at any time during 6 months of follow-up. The eradication of CF pathogens was accomplished in patients from all three lung infection groups: intermittently colonized, chronically infected, and lung transplanted. The patient with the longest follow-up had no bacterial growth for 3 years.. Extensive sinus surgery combined with intensive follow-up can eradicate pathogenic bacteria from CF sinuses.

Topics: Achromobacter denitrificans; Adolescent; Adult; Burkholderia; Burkholderia Infections; Child; Chronic Disease; Colistin; Cystic Fibrosis; Female; Follow-Up Studies; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Nasal Lavage; Paranasal Sinuses; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Rhinitis; Sinusitis; Treatment Outcome; Young Adult

Topics: Abscess; Cellulitis; Colistin; gamma-Globulins; Humans; Infections; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Methicillin; Neoplasms; Pharmacology; Pneumonia; Prednisone; Sepsis; Sinusitis; Statistics as Topic; Urinary Tract Infections