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Intranasal fluticasone in combination with cefuroxime in the treatment of acute rhinosinusitis

It is not yet known whether intranasal administration of glucocorticoids is effective in treating acute rhinosinusitis in patients who have a history of chronic or recurrent symptoms of sinusitis.

The objective of the double-blind, randomized, placebo-controlled study, published in the December issue of JAMA, was to determine whether adding intranasal glucocorticoids to standard antibiotics affects duration of disease and recurrence rate in patients with acute rhinosinusitis.

Between October 1998 and April 2000, 95 patients were included in the study in 22 centers. All patients had a history of chronic rhinitis or recurrent sinusitis, and the presence of an acute infectious process was confirmed radiologically and endoscopically.

The patients were randomized into two groups: the first (47 people) received fluticasone propionate (2 breaths in each nasal passage for 21 days, a daily dose of 200 mcg); the second (48 people) received a placebo as an intranasal spray. Both groups received cefuroxime axetil (250 mg x 2 times daily for 10 days) and xylometazoline hydrochloride (2 breaths in each nasal passage x 2 times daily for 3 days). Long-term outcomes (recovery or improvement) were assessed by interviewing patients over the phone 10, 21 and 56 days after treatment was completed.

88 people (93%) completed the study completely.

After analyzing the data, it turned out that in the group of patients receiving fluticasone, the clinical efficacy was significantly higher than in the group receiving placebo (93.5% vs 73.9%, respectively; p = 0.009). In addition, in patients receiving fluticasone, recovery was much faster than in patients receiving placebo (6.0 days vs 9.5 days; p = 0.01).

According to the results of the study, it can be concluded that polytherapy (fluticasone + antibiotic + xylometazoline hydrochloride) accelerates and considerably facilitates the healing process of patients suffering from recurrent chronic rhinosinusitis.