Whitehead Russell A, Talati Vidit, Baird Ali M, Owen Grant S, Hansen Romney, Filip Peter, Tajudeen Bobby A, Batra Pete S, Papagiannopoulos Peter
Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL.
Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA.
Am J Rhinol Allergy. 2025 Sep;39(5):364-370. doi: 10.1177/19458924251343389. Epub 2025 May 19.
BackgroundChronic rhinosinusitis (CRS) can be difficult to treat medically secondary to crusting and biofilms resistant to oral antibiotics. Treatment with topical antibiotics has grown in popularity due to their ability to administer a high local drug concentration while mitigating systemic effects. Published literature on topical antibiotic efficacy for CRS is mixed and sparse.ObjectiveTo describe the efficacy of postoperative topical mupirocin rinses in reducing objective and subjective markers of CRS disease severity.MethodsPatients with suspected biofilm formation following functional endoscopic sinus surgery who were treated with mupirocin 15 mg or 30 mg rinses twice daily between 2018-2023 were included. These patients' symptoms and endoscopic findings were refractory to high-volume steroid irrigations and oral antibiotics. Data collected involved comorbidities, rinse duration, concurrent therapies, Lund-Kennedy (LK) scores, sino-nasal outcome test-22 (SNOT) scores, and adverse effects. LK and SNOT scores were compared across 3 time points (preoperative, 3-month-postoperative-prerinse, postrinse) using one-way analysis of variance and Wilcoxon rank sum for pairwise comparisons.ResultsThirty patients were included. Average age was 63.3 years, 66.7% of patients were female, and 60% had nasal polyposis. There was a statistically significant decrease in LK scores between the 3-month-postoperative-prerinse period and the postrinse period (-0.92 ± 1.25; -value = ) whereas the SNOT-22 score reduction was not significantly different (-value = .62). One patient reported a "burning sensation" and stopped after 4-weeks of treatment; no other adverse events were reported.ConclusionTopical mupirocin rinses may result in improvement of CRS burden on endoscopy without a significant reduction in symptoms. Additional studies are necessary to delineate the safety and appropriate duration and dosing of mupirocin rinses as well as to compare mupirocin to standard saline irrigations for treatment of recalcitrant CRS.
背景
慢性鼻-鼻窦炎（CRS）由于结痂和对口服抗生素耐药的生物膜，药物治疗可能存在困难。局部用抗生素治疗因其能在减轻全身影响的同时给予高局部药物浓度而越来越受欢迎。关于CRS局部用抗生素疗效的已发表文献参差不齐且稀少。
目的
描述术后局部用莫匹罗星冲洗在降低CRS疾病严重程度的客观和主观指标方面的疗效。
方法
纳入2018 - 2023年间在功能性鼻内镜鼻窦手术后怀疑有生物膜形成且接受15毫克或30毫克莫匹罗星冲洗、每日两次治疗的患者。这些患者的症状和内镜检查结果对大容量类固醇冲洗和口服抗生素无效。收集的数据包括合并症、冲洗持续时间、同时进行的治疗、Lund-Kennedy（LK）评分、鼻窦结局测试-22（SNOT）评分以及不良反应。使用单因素方差分析和Wilcoxon秩和检验进行两两比较，在3个时间点（术前、术后3个月冲洗前、冲洗后）比较LK和SNOT评分。
结果
纳入30例患者。平均年龄为63.3岁，66.7%的患者为女性，60%有鼻息肉。术后3个月冲洗前期与冲洗后期之间LK评分有统计学显著下降（-0.92±1.25；P值 = ），而SNOT - 22评分降低无显著差异（P值 = 0.62）。一名患者报告有“烧灼感”，治疗4周后停止；未报告其他不良事件。
结论
局部用莫匹罗星冲洗可能会改善内镜下CRS的负担，但症状无显著减轻。需要进一步研究来明确莫匹罗星冲洗的安全性、合适的持续时间和剂量，以及将莫匹罗星与标准盐水冲洗用于治疗难治性CRS进行比较。
