Elliott Kimberly A, Stringer Scott P
Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
Am J Rhinol. 2006 Jan-Feb;20(1):1-6.
Chronic rhinosinusitis (CRS) refractory to medical and surgical therapy is a difficult problem for patients and physicians. Topical antimicrobial nasal irrigations are commonly used for treatment with great variation in methodology and without clear scientific support for current treatment formulations. The purpose of this study was to develop a scientific rationale for creating standardized recommendations for clinical practice in the use of topical antimicrobial washes for CRS.
An extensive review of basic science and clinical literature on the treatment of CRS with topical antimicrobial washes was completed. Pharmacokinetics of and organism susceptibility to appropriate topically applied antimicrobial agents were reviewed.
The most common organisms associated with CRS were identified. The relevant pharmacokinetics of drugs targeted at these organisms are presented. Susceptibility breakpoints set by the National Committee for Clinical Laboratory Standards are identified to help establish the most effective concentration of the identified drugs. Recommendations for agent selection, agent concentration, length of treatment, dosing schedule, and methods of irrigation are presented.
Antimicrobial nasal washes provide a potentially effective treatment for the growing population of patients who remain symptomatic after appropriate medical and surgical intervention. This study establishes the basic principles supporting this treatment option and offers rational, evidence-based treatment guidelines. The study has identified additional areas that need to be investigated before prospective clinical trials can be effectively undertaken.
对于患者和医生而言，药物及手术治疗均难以治愈的慢性鼻窦炎（CRS）是一个棘手的问题。局部使用抗菌药物进行鼻腔冲洗是常用的治疗方法，但其方法差异很大，且目前的治疗配方缺乏明确的科学依据。本研究旨在为制定CRS局部使用抗菌冲洗液的临床实践标准化建议提供科学依据。
全面回顾了关于局部使用抗菌冲洗液治疗CRS的基础科学和临床文献。回顾了适当局部应用抗菌药物的药代动力学及微生物敏感性。
确定了与CRS相关的最常见微生物。列出了针对这些微生物的药物的相关药代动力学。确定了美国国家临床实验室标准委员会设定的敏感性断点，以帮助确定所鉴定药物的最有效浓度。提出了关于药物选择、药物浓度、治疗时长、给药方案和冲洗方法的建议。
对于在适当的药物和手术干预后仍有症状的越来越多的患者，抗菌鼻腔冲洗提供了一种潜在有效的治疗方法。本研究确立了支持这种治疗选择的基本原则，并提供了合理的、基于证据的治疗指南。该研究还确定了在能够有效开展前瞻性临床试验之前需要进一步研究的其他领域。
