Treatment of chronic rhinosinusitis with intranasal amphotericin B: A randomized, placebo-controlled, double-blind pilot trial

Jens U. Ponikau, David A. Sherris, Amy Weaver, Hirohito Kita

Research output: Contribution to journalArticlepeer-review

188 Scopus citations

Abstract

Chronic rhinosinusitis (CRS) is one of the most common chronic diseases. Its etiology is unknown, and there is a paucity of effective medical treatments. We tested the hypothesis that intranasal antifungal treatment improves the objective computed tomography (CT) findings (inflammatory mucosal thickening), nasal endoscopy stages, and symptoms of CRS. A randomized, placebo-controlled, double-blind, single-center trial used amphotericin B to treat 30 randomly selected patients with CRS. Patients were instructed to instill 20 mL amphotericin B (250 μg/mL) or placebo to each nostril twice daily for 6 months. The primary outcome was a quantitative reduction in inflammatory mucosal thickening on CT scans of a standardized coronal cut. Secondary outcome measures were endoscopic scores, patient symptom scores, and levels of intranasal inflammatory mediators. Twenty-four patients completed the 6 months of treatment. Patients receiving amphotericin B achieved a relative reduction in the percentage of mucosal thickening on CT scans (n = 10; -8.8%) compared with placebo (n = 14; +2.5%; P =. 030). Likewise, the changes in the endoscopic scores improved in the amphotericin B group compared with placebo (P =. 038). Between-group comparisons of the changes in the intranasal mucus levels of eosinophil-derived neurotoxin showed a reduction in the amphotericin B group and an increase in the placebo group (P =. 046); levels of IL-5 showed similar tendencies (P =. 082). Intranasal amphotericin B reduced inflammatory mucosal thickening on both CT scan and nasal endoscopy and decreased the levels of intranasal markers for eosinophilic inflammation in patients with CRS.

Original languageEnglish (US)
Pages (from-to)125-131
Number of pages7
JournalJournal of Allergy and Clinical Immunology
Volume115
Issue number1
DOIs
StatePublished - Jan 1 2005

Keywords

  • Eosinophils
  • amphotericin B
  • antifungal
  • chronic rhinosinusitis
  • chronic sinusitis
  • nasal polyps

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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