mupirocin and Sinusitis

To review the recent literature of nasal irrigations with or without drugs, including delivery systems, nasal saline, antibiotics, antifungals, steroids, surfactants, and interleukin (IL)-5 modulators, for the treatment of chronic rhinosinusitis (CRS).. As antibiotic resistance increases in CRS, culture-directed, rather than empiric, topical antibiotics are increasingly critical in optimal treatment. Topical irrigation with mupirocin significantly reduces Staphylococcus aureus biofilm mass in vitro. Surfactants and humanized anti-IL-5 monoclonal antibody are novel therapies demonstrating promising results in CRS.. Physiologic saline irrigation is beneficial in the treatment of symptoms of CRS. Low-level evidence supports the effectiveness of topical antibiotics in the treatment of CRS. The use of topical antifungals is not supported by the majority of studies. Intranasal steroids are beneficial in the treatment of CRS with nasal polyposis. There is insufficient evidence to demonstrate a clear overall benefit for topical steroids in CRS without nasal polyposis.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Biofilms; Chronic Disease; Humans; Interleukin-5; Mupirocin; Nasal Lavage; Rhinitis; Sinusitis; Sodium Chloride; Staphylococcus aureus

Chronic rhinosinusitis (CRS) recalcitrant to surgery is a frustrating clinical entity. Recently, mupirocin sinonasal rinses have been suggested as an efficacious treatment alternative in these patients where Staphylococcus aureus infection is demonstrated. To our knowledge, how best to treat this S aureus reservoir has not been previously evaluated in a double-blinded, randomized, placebo-controlled trial.. Prospective, double-blinded, placebo-controlled study.. Twenty-five S aureus-positive CRS patients with persistent sinonasal infection despite endoscopic sinus surgery received either a 1-month, twice-daily treatment course of mupirocin sinonasal rinses (MUP) or saline rinses (CON). The primary outcome was S aureus-culture negativity at the conclusion of treatment; secondary rhinological outcomes included subjective and objective measures of rhinosinusitis.. Twenty-two patients satisfactorily completed the treatment period. Of CON patients, 0/13 (0.0%) returned an S aureus-negative sinonasal culture at 1 month, compared to 8/9 (88.9%) of MUP patients (P < .01). Improvements in rhinological outcomes observed in MUP patients following treatment were not subsequently evident when these patients were followed up at a delayed assessment 2 to 6 months after completing treatment.. Mupirocin sinonasal rinses are an effective short-term anti-S aureus treatment in surgically recalcitrant CRS as assessed by microbiological and selected rhinological outcomes, although the latter improvements may not be durable with time.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Chronic Disease; Double-Blind Method; Female; Humans; Male; Middle Aged; Mupirocin; Nasal Lavage; Nose; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

To examine the efficacy and tolerability of topical mupirocin for the management of surgically recalcitrant chronic rhinosinusitis (CRS) associated with Staphylococcus aureus infection.. Prospective open-label pilot study.. Patients with surgically recalcitrant CRS who had positive nasendoscopically guided cultures for Staphylococcus aureus were treated with twice daily nasal lavages containing 0.05% Mupirocin and lactated ringers salts. The duration of treatment was 3 weeks. Patients were assessed before and after treatment in terms of nasendoscopic findings, microbiology results, and Sinonasal Outcome Test (SNOT-20) and visual analogue scale questionnaires.. Fifteen of 16 patients had improved nasendoscopic findings after treatment. Twelve of 16 patients noted overall symptom improvement. Fifteen of 16 patients had negative swab results for Staphylococcus aureus after treatment. Only minimal adverse effects were experienced.. Nasal Lavage with 0.05% Mupirocin may represent an effective and well tolerated alternative treatment for postsurgical recalcitrant CRS.

Topics: Administration, Intranasal; Adult; Aged; Aged, 80 and over; Chronic Disease; Endoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mupirocin; Otorhinolaryngologic Surgical Procedures; Pilot Projects; Prospective Studies; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Therapeutic Irrigation; Treatment Outcome

Chronic rhinosinusitis (CRS) is a common condition negatively impacting a patient's quality of life. It has been hypothesized that bacterial biofilms are involved in the pathogenesis of CRS due to their persistence and difficulty to eradicate with conventional antibiotic therapy. Hence, the topical delivery of antibiotics via nasal rinse solution has gained a lot of attention due to the ability to deliver higher local concentrations, with less systemic absorption and side effects. This study investigates the efficacy of mupirocin dissolved in the 3 most commonly used sinus rinses in Australia Neilmed (isotonic saline), Flo Sinus Care (sodium chloride, sodium bicarbonate, potassium chloride, glucose anhydrous and calcium lactate and Pentahydrate) and FloCRS (sodium chloride, potassium chloride and xylitol).. Planktonic and biofilm cultures of S. aureus (ATCC25923, 2 methicillin-resistant S. aureus (MRSA) (C222 and C263), and 2 methicillin-susceptible S. aureus (MSSS) (C311 and C349) clinical isolates) were treated with mupirocin dissolved in three sinus rinses (Neilmed, Flo Sinus Care and FloCRS with different pH). To establish whether pH was a significant factor in determining antibiotic activity, experiments with Flo CRS were performed both at pH 5.64 and elevated pH 7.7. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined for planktonic cells. The biofilm biomass and metabolic activity were assessed by using crystal violet assay and alamarBlue assay respectively.. The combination of mupirocin in low pH (pH 5.64) sinus rinse (FloCRS) had the highest efficacy in reducing the growth of S. aureus in both the planktonic and biofilm forms. Mupirocin diluted in FloCRS (pH 5.64) showed a significantly higher reduction in both biomass and metabolic activity than that was observed when mupirocin was diluted in Neilmed, Flo Sinus Care or FloCRS (pH 7.7).. The choice of irrigant solution for topical mupirocin delivery appears to be important for antimicrobial activity. The delivery of mupirocin via low pH FloCRS could be useful in eliminating S. aureus biofilms present on the sinus mucosa of patients with CRS.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Humans; Hydrogen-Ion Concentration; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Quality of Life; Sinusitis; Staphylococcal Infections; Staphylococcus aureus

The incidence of refractory chronic rhinosinusitis (CRS) associated with methicillin-resistant Staphylococcus aureus (MRSA) is rising and remains a therapeutic challenge. The goal of this study is to demonstrate the efficacy of a non-invasive topical therapy against MRSA in these patients.. Seventeen patients with refractory CRS caused by MRSA were treated with a topical therapy protocol. Treatment consisted of weekly endoscopic sinus debridement followed by intra-sinus installation of a hydroxyl-ethylcellulose gel that releases mometasone and a culture-directed antibiotic for a period of 6 weeks, along with daily nasal nebulization of mometasone with the same antibiotic and saline rinses. Clinical outcome was assessed using the Lund-Kennedy (LK) symptom and endoscopic appearance scores. Sinus mucosal tissue was homogenized and cultured, and microbial biofilm burden was assessed based on colony forming units (CFUs) counts.. Rhinotopic therapy resulted in clearance of MRSA in 13 of 16 patients (81.2%). Treated patients also demonstrated significant improvement clinically as measured by the LK scores. In addition, a significant decrease in mucosal CFUs was observed post-therapy.. Our findings demonstrate that topical therapy is an effective method for treating MRSA-associated refractory CRS.

Topics: Administration, Intranasal; Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Cellulose; Culture Techniques; Debridement; Endoscopy; Female; Humans; Instillation, Drug; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mometasone Furoate; Mupirocin; Nebulizers and Vaporizers; Prospective Studies; Rhinitis; Saline Solution; Sinusitis; Staphylococcal Infections; Therapeutic Irrigation; Tobramycin; Treatment Outcome; Vancomycin

Topical mupirocin therapy is used to treat symptomatic chronic sinusitis (CRS). However, the potential adverse impact of this therapy on the sinus microbiota has not been well quantified.. To determine changes in microbiologic culture results before and after topical mupirocin therapy in patients with CRS with medically and surgically refractory disease.. We performed a retrospective medical chart review for 22 consecutive adults evaluated and treated between January 1, 2012, and January 1, 2014, at an otolaryngology-rhinology clinic at a regional academic medical center. The patients were 14 men and 8 women, who had undergone functional endoscopic sinus surgery for CRS, and in whom sinus aspirate cultures were performed before and after topical mupirocin therapy for symptomatic disease. Analyses were performed in April 2014.. Patients underwent treatment with saline sinus rinse, with the addition of mupirocin, for at least 1 week.. Bacterial isolates from sinus aspirate culture.. The patients included 14 men and 8 women, 18 to 75 years old, who underwent a mean of 1.9 functional endoscopic sinus surgical procedures. The mean (range) duration of mupirocin therapy was 6 (2-12) weeks. Before mupirocin therapy, cultures from symptomatic patients (14 men and 8 women, ages 18-75 years) revealed common bacteria implicated in CRS, which are characteristically gram-positive. After mupirocin therapy, cultures from symptomatic patients shifted significantly: 19 were gram-positive vs 3 gram-negative before treatment; 9 were gram-positive vs 13 gram-negative after treatment (P = .004), with increased growth of pathogenic gram-negative bacteria and Corynebacterium.. These data present evidence supporting the distinct abrogation of culturable sinus bacteria after mupirocin rinses, identifying a shift toward increased pathogenic bacteria. Consideration of healthy host microbiome and immune dysfunction should guide future treatment considerations.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Bacterial Agents; Chronic Disease; Combined Modality Therapy; Endoscopy; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Retrospective Studies; Rhinitis; Sinusitis; Treatment Outcome

Saline irrigation of the nasal cavity is a classic and effective treatment for acute or chronic rhinosinusitis. Topical antibiotics such as mupirocin have been widely used for recalcitrant chronic rhinosinusitis. Therefore, the purpose of this study was to evaluate the effect of saline irrigation using mupirocin.. A systematic literature review and meta-analysis of mupirocin saline irrigation were performed using EMBASE, MEDLINE, and Cochrane library through December 2015. Data were analyzed with R 3.2.2 software. A random effects model was used because of the diversity of included studies. Sensitivity analysis of particular tested groups and single proportion tests were also performed. The main outcome measure was residual staphylococcal infection, as confirmed by culture or PCR.. Two RCTs, two prospective studies and two retrospective studies were included. A random effects model meta-analysis of the pooled data identified a relative risk of residual infection of 0.13 (95% CI: 0.06-0.26, p<0.05) with low heterogeneity (I2 = 0%). The proportion of residual staphylococcal infections after 1 month was 0.08 (95% CI: 0.04-0.16). However, this proportion increased to 0.53 at 6 months (95% CI: 0.27-0.78).. The short-term use of mupirocin has a strongly reductive effect on staphylococcal infection in chronic rhinosinusitis. Although there is currently a lack of clear evidence, future studies with well-designed inclusion criteria and randomized controlled trials are needed to examine mupirocin's long-term effect on chronic rhinosinusitis.

Topics: Administration, Intranasal; Humans; Mupirocin; Nasal Cavity; Nasal Lavage; Paranasal Sinuses; Randomized Controlled Trials as Topic; Retrospective Studies; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus; Therapeutic Irrigation

Topics: Adrenal Cortex Hormones; Animals; Anti-Bacterial Agents; Biofilms; Disease Models, Animal; Humans; In Situ Hybridization, Fluorescence; Mupirocin; Rhinitis; Sheep; Sinusitis; Staphylococcal Infections; Staphylococcus aureus

Antibiotic irrigations are occasionally used during endoscopic sinus surgery when gross mucosal infection is present. These irrigations are thought to flush out pathogenic bacteria and decrease the bacterial load within the mucosal surfaces. This treatment, however, has not been studied in vivo and it is unknown whether antibiotic rinses produce a quantitative reduction in pathologic bacteria within the sinus mucosa. The objective of this study was to determine the relative abundance of Staphylococcus aureus within the maxillary sinus and to evaluate the impact of intraoperative mupirocin irrigation on bacterial burden.. Sixteen patients with symmetric maxillary chronic rhinosinusitis were prospectively enrolled. After bilateral maxillary antrostomies, biopsies were taken of the maxillary sinus mucosa on both sides. In each patient, the right side was irrigated with 240 mL of normal saline (NS) and the left side was irrigated with 240 mL of NS mixed with 60 mg mupirocin. Repeat maxillary sinus mucosal biopsies were taken from each side 7 to 10 days postsurgery. Each biopsy was analyzed using quantitative polymerase chain reaction to determine the presence and relative amount of S. aureus.. Mupirocin irrigations were found to significantly reduce the amount of S. aureus found within the maxillary sinus mucosa compared to NS alone. The average fold change between the pre- and posttreatment biopsies on the right and left was 9.05 and 97.42, respectively (p < 0.01).. Intraoperative mupirocin irrigations significantly reduce the amount of S. aureus detected within the diseased sinus mucosa at up to 10 days postoperatively.

Topics: Anti-Bacterial Agents; Chronic Disease; Female; Humans; Male; Maxillary Sinus; Middle Aged; Mupirocin; Nasal Lavage; Nasal Polyps; Polymerase Chain Reaction; Prospective Studies; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

It has been postulated that bacterial biofilms are involved in the pathogenesis of chronic rhinosinusitis (CRS). Biofilms present on sinus mucosa are difficult to eradicate with conventional antibiotic therapy and are thought to provide a nidus for recurrent infection. Topical delivery of antibiotics via nasal irrigation may present a way of delivering high concentrations of antibiofilm agents with potentially low systemic absorption and side effects. This study investigates the effectiveness of mupirocin and two other antibiotics, ciprofloxacin and vancomycin, on established in vitro biofilms of Staphylococcus aureus isolated from patients with CRS.. S. aureus American Type Culture Collection 25923 and 12 clinical isolates were investigated for their ability to form biofilms in an in vitro setting using a 96 well microtiter crystal violet (CV) plate assay and confocal scanning laser microscopy (CSLM). Antimicrobial susceptibility tests to determine minimum inhibitory concentrations were performed on planktonic and biofilm forming strains. In addition, established biofilms were subjected to the antimicrobial agents at a twofold dilution series. A CV analysis of biofilm mass was performed after 1 and 24 hours of treatment, and minimum biofilm inhibition concentrations at 50% (MIB50) and 90% (MIB90) biofilm inhibition were recorded.. With use of a 96-well microtiter plate CV assay, 8 of the 12 clinical isolates formed mature biofilms after 8 days of culture. These results correlated with findings from CSLM analysis of in vitro biofilms grown on Permanox chamber slides. Increased antimicrobial resistance was observed in the biofilm isolates when compared with planktonic counterparts. Mupirocin was capable of reducing biofilm mass by greater than 90% at concentrations of 125 mug/mL or less in all S. aureus isolates. Ciprofloxacin and vancomycin were largely ineffective in attaining MIB90 concentrations within safe dosage ranges.. The topical application of mupirocin via nasal irrigation may be useful in eliminating S. aureus biofilms present on the sinus mucosa of patients with CRS and may offer an additional treatment to patients with recalcitrant sinusitis.

Topics: Anti-Bacterial Agents; Biofilms; Chronic Disease; Humans; Microbial Sensitivity Tests; Mupirocin; Rhinitis; Sinusitis; Staphylococcus aureus