Intervention Review

Topical and systemic antifungal therapy for the symptomatic treatment of chronic rhinosinusitis

  1. Peta-Lee Sacks2,
  2. Richard J Harvey1,*,
  3. Janet Rimmer3,
  4. Richard M Gallagher1,
  5. Raymond Sacks4

Editorial Group: Cochrane Ear, Nose and Throat Disorders Group

Published Online: 10 AUG 2011

Assessed as up-to-date: 7 MAR 2011

DOI: 10.1002/14651858.CD008263.pub2

Database Title

Additional Information

How to Cite

Sacks PL, Harvey RJ, Rimmer J, Gallagher RM, Sacks R. Topical and systemic antifungal therapy for the symptomatic treatment of chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD008263. DOI: 10.1002/14651858.CD008263.pub2.

Author Information

  1. 1

    St Vincent's Hospital, Department of Otolaryngology, Head and Neck Surgery, Sydney, NSW, Australia

  2. 2

    St Vincent's Hospital, St Vincent's Clinical School, Sydney, Australia

  3. 3

    St Vincent's Hospital, Department of Thoracic Medicine, Sydney, NSW, Australia

  4. 4

    Concord Repatriation Hospital, Department of Otolaryngology, Head and Neck Surgery, Sydney, Australia

*Richard J Harvey, Department of Otolaryngology, Head and Neck Surgery, St Vincent's Hospital, 354 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia. richard@sydneyentclinic.com. richard@richardharvey.com.au.

Publication History

  1. Publication Status: New
  2. Published Online: 10 AUG 2011

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Background

Chronic rhinosinusitis (CRS) is an inflammatory disorder of the nose and sinuses. Since fungi were postulated as a potential cause of CRS in the late 1990s, there has been increasing controversy about the use of both topical and systemic antifungal agents in its management. Although interaction between the immune system and fungus has been demonstrated in CRS, this does not necessarily imply that fungi are the cause of CRS or that antifungals will be effective its management.

Objectives

To assess the effectiveness of topical or systemic antifungal therapy in the treatment of CRS.

Search methods

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 8 March 2011.

Selection criteria

All randomised, placebo-controlled trials considering the use of topical or systemic antifungal therapy in the treatment of CRS and allergic fungal sinusitis (AFS). CRS was defined using either the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) or American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) criteria.

Data collection and analysis

We reviewed the titles and abstracts of all studies obtained from the searches and selected trials that met the eligibility criteria. We extracted data using a pre-determined data extraction form. There was significant heterogeneity of outcome data reporting with reports containing both parametric and non-parametric representations of data for the same outcomes. Means and standard deviations for change data were unavailable for a number of trials. Due to the limited reported data, we contacted authors and used original data for data analysis.

Main results

Six studies were included (380 participants). Five studies investigated topical antifungals and one study investigated systemic antifungals. The risk of bias in all included studies was low, with all trials being double-blinded and randomised. Pooled meta-analysis showed no statistically significant benefit of topical or systemic antifungals over placebo for any outcome. Symptom scores in fact statistically favoured the placebo group. Adverse event reporting was statistically significantly higher in the antifungal group.

Authors' conclusions

On the basis of this meta-analysis, there is no evidence to support the use of either topical or systemic antifungal treatment in the management of CRS.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antifungal therapy for chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is an extremely common condition. Since fungus has been implicated in the development of CRS, it has been proposed that antifungal therapies may be beneficial in its treatment. As antifungals can be expensive and are associated with side effects, it is imperative that the benefits of this therapy are well-documented before broadly endorsing it as treatment. This review summarises the evidence for the efficacy of both topical and systemic antifungal therapies in the management of symptoms in CRS. We included six studies with a total of 380 patients in the review. There is no evidence that either topical or systemic antifungal therapies have any benefit over placebo for the symptomatic treatment of CRS and therefore there is no evidence to support their use.

 

Resumen

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Tratamiento antimicótico tópico y sistémico para el tratamiento sintomático de la rinosinusitis crónica

La rinosinusitis crónica (RSC) es un trastorno inflamatorio de la nariz y los senos paranasales. Desde que se postuló, a fines de los años noventa, que los hongos podrían ser una causa de RSC, aumentó la polémica acerca del uso de agentes antimicóticos, tanto tópicos como sistémicos, en su tratamiento. Aunque se ha demostrado la interacción entre el sistema inmunológico y los hongos en la RSC, este hecho no necesariamente implica que los hongos sean la causa de la RSC o que los antimicóticos sean efectivos para su tratamiento.

Objetivos

Evaluar la efectividad del tratamiento antimicótico tópico o sistémico para la rinosinusitis crónica.

Estrategia de búsqueda

Se hicieron búsquedas en el Registro de Ensayos del Grupo Cochrane de Enfermedades de Oído, Nariz y Garganta (Cochrane Ear, Nose and Throat Disorders Group); Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials, CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP y fuentes adicionales de ensayos publicados y no publicados. La fecha de la búsqueda más reciente fue el 8 de marzo 2011.

Criterios de selección

Todos los ensayos aleatorios, controlados con placebo, que consideran el uso de antimicóticos tópicos o sistémicos en el tratamiento de la RSC y la sinusitis micótica alérgica (SMA). La RSC se definió de acuerdo con los criterios del European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) o la American Academy of Otolaryngology  Head and Neck Surgery (AAOHNS).

Obtención y análisis de los datos

Se revisaron los títulos y los resúmenes de todos los estudios obtenidos a partir de las búsquedas y se seleccionaron los ensayos que cumplían con los criterios de inclusión. Se extrajeron los datos utilizando un formulario de extracción de datos predeterminado. Se halló significativa heterogeneidad en la notificación de los datos de resultado, con informes que contenían representaciones de los datos tanto paramétricas como no paramétricas para los mismos resultados. Varios ensayos no proporcionaron las medias y las desviaciones estándar para los datos de cambio. Debido a las limitaciones de los datos informados, se estableció contacto con los autores y se utilizaron datos originales para el análisis.

Resultados principales

Se incluyeron seis estudios (380 participantes). Cinco estudios investigaron antimicóticos tópicos y un estudio investigó antimicóticos sistémicos. El riesgo de sesgo en todos los estudios incluidos fue bajo; todos los ensayos eran doble ciego y aleatorios. El metanálisis agrupado no arrojó un beneficio estadísticamente significativo de los antimicóticos tópicos o sistémicos, en comparación con el placebo, en ningún resultado. De hecho, las puntuaciones de los síntomas favorecieron estadísticamente el grupo placebo. El informe de los eventos adversos fue estadística y significativamente mayor en el grupo de antimicóticos.

Conclusiones de los autores

Sobre la base de este metanálisis, no existen pruebas para apoyar el uso de antimicóticos tópicos o sistémicos en el tratamiento de la RSC.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

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