Amphotericin B Nasal Irrigation as an Adjuvant Therapy after Functional Endoscopic Sinus Surgery

Abstract

Our study showed that nasal irrigation with 100 μg/mL of AMB did not confer a greater benefit than that of NS solution nasal irrigation in post-FESS care.

Chronic rhinosinusitis phenotypes

“…These investigators intriguingly demonstrated that subjects with E-CRS (and not the healthy controls) had circulating T effector lymphocytes that secreted IL-5 in response to Alternaria 56 . Subsequently, this line of research has been dismissed because of the overwhelming evidence that sinus irrigation with anti-fungal antibiotics fails to produce clinical benefit 57, 58 . However, that seems an unfair argument against this as a mechanism, as anti-fungals are consistently ineffective in AFRS despite universal acceptance that it is a fungally-mediated disease.…”

Efficacy of nasal irrigation with 200 μg/mL amphotericin B after functional endoscopic sinus surgery: a randomized, placebo‐controlled, double‐blind study

“…The lower concentration of 100 μg/mL used in our previous study is commonly recommended, while other studies proposed the use of higher concentrations . Our earlier study of post‐FESS care showed that nasal irrigation with 100 μg/mL concentration of AMB did not provide benefits over saline controls . In the present study, we adopted the concentration of 200 μg/mL.…”

“…Nasal irrigation is a common adjuvant treatment after functional endoscopic sinus surgery (FESS). In our previous study, a concentration of 100 μg/mL of AMB at a daily dose of 20 mg was used for the irrigation after FESS, and we found no benefits over the control irrigation with saline . Whether higher AMB concentration would improve the benefit of post‐FESS care is uncertain.…”

“…Therefore, intranasal AMB solution has been used for its treatment. Given that the surgical removal of obstructing tissues facilitates intranasal irrigation, topical application of AMB solution might be beneficial in the postoperative care of FESS . Gerlinger et al .…”

Failure of Itraconazole to Prevent T-Helper Type 2 Cell Immune Deviation: Implications for Chronic Rhinosinusitis

“…30 Subsequently, enthusiasm for this line of research has been diminished due to overwhelming evidence that sinus irrigation with antifungal agents fail to produce clinical benefit. [31][32][33] Our assumption going into this study was that the actions of azole antifungals would be to prevent de novo differentiation of naive T cells. Because this demonstrably is not its mechanism of action, the alternative explanation, in regard to potential actions on effector T cells, would be to inhibit the function, proliferation, or survival of established effector T cells.…”