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Itraconazole Use Shows Promise in Chronic Sinusitis: Presented at EAACI
By Jill Stein
PARIS, FRANCE -- June 10, 2003 -- Selective use of itraconazole appears to be safe and effective in some chronic sinusitis patients, say researchers.
This finding was announced at the 22nd Congress of the European Academy of Allergology and Clinical Immunology (EAACI) by Dr. Karl W. Baumgart, with Royal Prince Alfred Hospital Camperdown in Sydney, Australia. The study investigated 48 patients with persistent sinusitis, despite the use of conventional strategies, who were then treated with itraconazole, 100 mg bid for 3 months
Conventional strategies included surgery to restore ostial patency; management of salicylate/aspirin sensitivity by diet modification, anti-histamine, and anti- leukotriene blockade, and aspirin avoidance or desensitisation.
The decision to use an anti-fungal treatment in these patients was based on the recognition that fungal colonization may cause chronic sinusitis. Overall, 32 (66%) patients had a significant improvement in symptoms, and benefit was evident as early as 3 to 6 weeks after the start of treatment.
Itraconazole treatment was safe and well tolerated, although 2 patients complained of weight gain. Four patients did deteriorate during treatment and were subsequently referred for functional endoscopic sinus surgery during treatment.
Dr. Baumgart said that prospective randomised, clinical trials may be useful for determining whether itraconazole treatment in parallel with initial surgery might reduce the need for repeat surgery or perhaps eliminate the need for surgery altogether. Studies are also needed to identify which patients are most likely to benefit and what is the optimal duration for treatment.
At present, the researchers treat chronic sinusitis patients who have failed standard treatments with itraconazole, 100 mg bid for 3 months, followed by an additional 3 months of itraconazole, 100 mg once daily.
Finally, he emphasized that itraconazole treatment should be used only as a "rescue remedy" in patients who have persistent disease despite the "valiant" efforts of ear, nose, and throat surgeons and the use of all other standard measures.
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