Fluticasone aids antibiotic rhinosinusitis therapy

By David Douglas

NEW YORK (Reuters Health) – Supplementary use of intranasal fluticasone propionate in patients receiving antimicrobial therapy for rhinosinusitis improves success rates and speeds recovery, researchers report in the December 26th issue of the Journal of the American Medical Association.

Dr. Rowena J. Dolor of Duke Clinical Research Institute, Durham, North Carolina, and colleagues note that this type of combination is often employed in patients with chronic, persistent sinusitis. However, such use "has not been rigorously studied."

"Our goal," Dr. Dolor told Reuters Health, "was to examine the benefits of adding an intranasal corticosteroid to standard antibiotic therapy."

The researchers conducted a double-blind study of 95 patients with a history of chronic rhinitis or recurrent sinusitis and evidence of acute infection. All received 2 puffs of xylometazoline hydrochloride in each nostril twice daily for 3 days and 250 mg of cefuroxime axetil twice daily for 10 days. They were also randomized to receive 2 puffs of fluticasone or placebo nasal spray in each nostril once daily for 21 days.

In the 88 patients evaluated, clinical success was significantly higher in the fluticasone than in the placebo group (93.5% versus 73.9%). Treatment success was also significantly quicker (6.0 versus 9.5 days).

More rapid improvement for a self-limited disease like sinusitis, added Dr. Dolor, "is key because it is associated with greater productivity in working populations."

"Since the majority of study sites were community-based primary care or otolaryngology clinics, our results are highly generalizable to usual clinical practice," she said, "and are compelling enough to recommend that clinicians include intranasal corticosteroids as part of the therapeutic regimen for the treatment of acute sinusitis in patients with a history of recurrent or chronic sinus symptoms."

JAMA 2001;285:3097-3105.

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