fosfomycin and Sinusitis

effects of Fosfomycin (FOM) nebulizer therapy were studied in patients with chronic sinusitis.. about 28 patients with chronic sinusitis were administered 2 ml of FOM sodium (3% w/v) by nebulizer three times per week for 4 weeks. Levels of IL-1 beta, IL-6, IL-8, and TNF-alpha in nasal lavage were also measured before and at the end of treatment.. the overall efficacy of this treatment on the basis of both subjective and objective symptoms, was 'excellent' for 28.6%, 'good' for 10.7%, 'fair' for 39.4%, and yield 'no change' for 21.4% of the patients. Both IL-1 beta and IL-6 concentrations were significantly decreased after treatment. Although the IL-8 level did not significantly decrease, it seems to be related to the overall efficacy. TNF-alpha was not detected in all of the samples.. FOM nebulization therapy is highly effective in treatment for chronic sinusitis, and efficacy may be due to an immunomodulatory mechanism, as well as its bactericidal effect.

Topics: Adolescent; Adult; Aged; Child; Chronic Disease; Drug Administration Schedule; Exudates and Transudates; Female; Fosfomycin; Haemophilus Infections; Humans; Interleukins; Male; Middle Aged; Nebulizers and Vaporizers; Sinusitis; Streptococcal Infections; Treatment Outcome; Tumor Necrosis Factor-alpha

Multi-center bacteriological and clinical studies on fosfomycin (FOM) nasal solution were performed in subjects with paranasal sinusitis from January, 1988 to May, 1990. In these studies, we were exclusively responsible for bacterial isolation from clinical sources, bacterial identification and the determination of drug susceptibility. Before local administration of FOM nasal solution, many strains of various bacterial species were isolated from sources totalling 396 cases involved in phase II clinical studies, dose-finding and open clinical studies. From antibacterial activities of FOM against those isolates, we obtained the following conclusions. 1. Among the 447 isolates, Streptococcus spp. occupied 25.7%, Staphylococcus spp. 21.7% and anaerobic Gram-positive cocci (GPC) 13.6%, showing high detection frequency of aerobic and anaerobic GPC. Next to these, Haemophilus influenzae, Pseudomonas aeruginosa, Klebsiella spp. and Branhamella catarrhalis also were often obtained. 2. After exclusion of possibly contaminating strains which might have entered into cultures at samplings or transfers, the MIC50 and the MIC80 of FOM against the remaining 354 isolates were determined to be 12.5 and 25 micrograms/ml, respectively, indicating that local use of FOM would be fully effective to eradicate most of the bacteria. 3. FOM nasal solution showed sufficient eradication efficacy against most clinical isolates of possible causative organisms of paranasal sinusitis, and appeared to be useful as a topical preparation for the treatment of this disease.

Topics: Administration, Intranasal; Bacteria; Drug Evaluation; Fosfomycin; Humans; Sinusitis; Staphylococcus; Streptococcus

We present a case of toxic shock syndrome (TSS) induced by MRSA after sinus surgery. The patient was a 64-year-old woman who had undergone sinus surgery because of chronic sinusitis. Nine days after the surgery, she began to have sore throat, fever, and diffuse erythroderma followed by severe hypotension and renal dysfunction. Culture of sputum, nasal discharge and stool showed MRSA. Blood culture was negative. She was treated with intravenous fluids, catecholamines and antibiotics (vancomycin and fosfomycin). Continuous hemodiafiltration was started because of oliguria. Her condition improved gradually and she was discharged about a month after the onset of her illness. We should recognize that TSS can occur as a fatal complication after nasal surgery.

Topics: Chronic Disease; Drug Therapy, Combination; Female; Fosfomycin; Hemodiafiltration; Humans; Methicillin Resistance; Middle Aged; Postoperative Complications; Shock, Septic; Sinusitis; Staphylococcal Infections; Vancomycin

Surface and tissue transitional concentration of 3% FOM aerosol for treatment of paranasal sinusitis was examined in 18 patients (21 sides) who underwent the Caldwell-Luc operation. In this operation, patients have a bony window on the sinus; we therefore investigated the difference of compliance of the maxillary sinus between when we closed the bony window with subcutaneous tissue and when we did it with a silicone sheet before the FOM nebulization. No significance was found in the mean concentration of FOM either at the maxillary sinus surface or in the tissue with or without the use of the silicone sheet. We also examined the concentration using a jet-type nebulizer and an ultra-sonic type nebulizer. Using the ultrasonic-type nebulizer resulted in a higher transitional concentration at two sites of the maxillary sinus surface than when using the jet-type nebulizer. The results suggest that the ultrasonic-type nebulizer is more effective in the treatment of paranasal sinusitis than the jet-type, and that there was no change of maxillary sinus compliance with or without a bony window.

Topics: Anti-Bacterial Agents; Fosfomycin; Humans; Maxillary Sinus; Nebulizers and Vaporizers; Retrospective Studies; Sinusitis

In order to examine antimicrobial activities of fosfomycin (FOM), the minimum inhibitory concentrations (MICs) of FOM and those of control drugs were determined against Streptococcus pneumoniae and Haemophilus influenzae isolated from sinusitis patients from September to November, 1993, and the following results were obtained. 1. Among 50 S. pneumoniae strains tested, there were 10 strains (20.0%) of benzylpenicillin (PCG)-insensitive S. pneumoniae (PISP) and 2 strains (4.0%) of PCG-resistant S. pneumoniae (PRSP); but the MIC distributions of FOM among the PISPs and the PRSPs were almost identical to those among the PCG-susceptible S. pneumoniae (PSSP). 2. There were 12 strains (24.0%) of beta-lactamase producing strains among 50 strains of H. influenzae tested, but the FOM's MIC distribution among these strains was almost identical to that among beta-lactamase non-producing strains. 3. The results obtained on the MIC90s of FOM against S. pneumoniae and H. influenzae suggest that the nebulization treatment with FOM nasal preparation satisfies the condition "above the MIC".

Topics: Drug Resistance, Microbial; Fosfomycin; Haemophilus influenzae; Humans; Sinusitis; Streptococcus pneumoniae

Topics: Administration, Inhalation; Aminoglycosides; Anti-Bacterial Agents; Cefmenoxime; Fosfomycin; Humans; Nebulizers and Vaporizers; Sinusitis; Staphylococcal Infections