Lim Mingyann, Citardi Martin J, Leong Jern-Lin
Department of Otolaryngology, Singapore General Hospital, Singapore.
Am J Rhinol. 2008 Jul-Aug;22(4):381-9. doi: 10.2500/ajr.2008.22.3189.
Chronic rhinosinusitis (CRS) is a common disease that can significantly impact health. The mainstay of medical treatment is topical steroids and oral antibiotics, but little is known about the efficacy of topical antibiotics. The purpose of this study was to identify evidence for the use of topical antibiotics in the treatment of CRS and exacerbations of CRS.
Systematic review of literature with a search of the MEDLINE, EMBASE, and CINAHL databases; Cochrane Central Register of Controlled Trials (Third Quarter 2007); and Cochrane Database of Systemic Reviews (3rd Quarter 2007) databases were performed. The dates of search were from December 1, 1949 to September 30, 2007.
Fourteen studies that fulfilled the inclusion criteria were identified: seven were controlled trials and of these, five were double blinded and randomized. Only one of the randomized studies showed a positive outcome. Overall, there was low-level corroborative evidence for the use of antibacterials. No definite conclusions could be made regarding the use of antifungals. Currently, there is evidence for the use of nasal irrigation or nebulization rather than delivery by nasal spray. For the antibacterial studies, the highest level of evidence currently exists for studies that have used postsurgical patients and culture-directed therapy. Both stable and acute exacerbations of CRS appear to benefit from topical antimicrobials.
Topical antibiotics appear effective in the management of CRS. Given the combination of low-level evidence (level III, with inherent potential confounders of natural progression of disease and placebo effect) and the level IIb evidence being limited to the cystic fibrosis group of patients, topical antibiotics should not be first-line management but may be attempted in patients refractory to the traditional topical steroids and oral antibiotics. Larger and better-designed randomized double-blind placebo-controlled trials are required to more fully evaluate this emerging modality of treatment.
慢性鼻-鼻窦炎（CRS）是一种常见疾病，会对健康产生重大影响。药物治疗的主要手段是局部用类固醇和口服抗生素，但局部用抗生素的疗效鲜为人知。本研究的目的是确定局部用抗生素治疗CRS及其加重期的证据。
通过检索MEDLINE、EMBASE和CINAHL数据库、Cochrane对照试验中心注册库（2007年第三季度）以及Cochrane系统评价数据库（2007年第三季度）对文献进行系统评价。检索日期为1949年12月1日至2007年9月30日。
确定了14项符合纳入标准的研究：7项为对照试验，其中5项为双盲随机试验。只有1项随机研究显示出阳性结果。总体而言，使用抗菌药物的证据水平较低。关于使用抗真菌药物，无法得出明确结论。目前，有证据支持使用鼻腔冲洗或雾化，而非鼻喷雾剂给药。对于抗菌药物研究，目前证据水平最高的是针对术后患者和根据培养结果指导治疗的研究。CRS的稳定期和急性加重期似乎都能从局部用抗菌药物中获益。
局部用抗生素似乎对CRS的治疗有效。鉴于证据水平较低（III级，存在疾病自然进展和安慰剂效应等内在潜在混杂因素），且IIb级证据仅限于囊性纤维化患者群体，局部用抗生素不应作为一线治疗方法，但对于对传统局部用类固醇和口服抗生素治疗无效 的患者，可以尝试使用。需要开展规模更大、设计更优的随机双盲安慰剂对照试验，以更全面地评估这种新兴的治疗方式。
