Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Int Forum Allergy Rhinol. 2011 Sep-Oct;1(5):382-9. doi: 10.1002/alr.20088. Epub 2011 Aug 18.
The objective of the evidence base review was to systematically evaluate the literature to elucidate the potential role of oral antifungal therapy in management of chronic rhinosinusitis (CRS) and its subtypes.
Articles for inclusion were identified by query of appropriate search terms in the PubMed database. The articles were reviewed independently by 2 authors and assigned an evidence level. The composite outcome data was reviewed to determine the impact of oral antifungals in CRS.
The search yielded 356 abstracts for review, retrieved 60 articles for full review, and incorporated 28 studies in this report. The majority of literature included level 4 (15) and level 5 (12) studies. One study met criteria for level 1 evidence. Most common disease entity studied was allergic fungal rhinosinusitis in 19 series; the most common antifungals reported were itraconazole and ketoconazole in 19 and 6 studies, respectively. Subjective parameters were assessed in 12 (42.8%) studies; overall, 64 (78%) of 82 patients reported symptom resolution or improvement. Objective parameters were reported in 6 (21.4%) studies, including improvement in endoscopic findings (3), CT imaging (3), reduction in oral steroid usage (1), and less revision surgery (2). Median length of follow-up was 14.7 months (3-60).
The composite data suggests a potential beneficial effect of oral itraconazole and ketoconazole in patients with CRS and its subtypes. However, majority of the studies are uncontrolled case series, confounded by non-validated outcome variables. Randomized controlled trials are required to better elucidate their role in CRS.
本循证医学文献回顾的目的是系统评估文献，以阐明口服抗真菌治疗在慢性鼻-鼻窦炎（CRS）及其亚型治疗中的潜在作用。
通过在 PubMed 数据库中查询合适的检索词来确定纳入文献。由两位作者独立对文献进行评估，并分配证据等级。综合分析观察结果数据以确定口服抗真菌药物对 CRS 的影响。
检索共得到 356 篇摘要进行审阅，获得 60 篇全文进行评估，并纳入本报告中的 28 项研究。大多数文献属于 4 级（15 项）和 5 级（12 项）研究。仅有 1 项研究符合 1 级证据标准。研究中最常见的疾病实体是变应性真菌性鼻-鼻窦炎，有 19 项研究；报道最常见的抗真菌药物是伊曲康唑和酮康唑，分别有 19 项和 6 项研究报道。有 12 项（42.8%）研究评估了主观参数；总体而言，82 例患者中有 64 例（78%）报告症状缓解或改善。有 6 项（21.4%）研究报告了客观参数，包括内镜检查结果改善（3 项）、CT 影像学改善（3 项）、口服类固醇使用减少（1 项）和手术翻修减少（2 项）。中位随访时间为 14.7 个月（3-60 个月）。
综合数据表明，口服伊曲康唑和酮康唑对 CRS 及其亚型患者可能具有潜在的有益作用。然而，大多数研究为非对照病例系列研究，受到非验证的结局变量的影响。需要进行随机对照试验以更好地阐明它们在 CRS 中的作用。
