A prospective study comparing Itraconazole and systemic steroids as an
adjunct to topical steroids in the post-operative management of Allergic
fungal rhinosinusitis
Abstract
Title: A prospective study comparing Itraconazole and systemic steroids
as an adjunct to topical steroids in the post-operative management of
Allergic fungal rhinosinusitis ABSTRACT Objectives The objective of this
study was to compare the efficacy of Itraconazole and systemic steroids
as an adjuvant to topical steroids in post-operative patients with
Allergic Fungal Rhinosinusitis (AFRS) using both subjective and
objective outcome measurements. Methods A prospective comparative study
was conducted in a tertiary care center on 60 patients diagnosed with
AFRS. Patients with chronic systemic illness and those undergoing
revision surgery were excluded. Post-operative patients were divided
into two groups of 30 each which received Itraconazole 400 mg OD or
Methylprednisolone in tapering doses over six weeks. The outcomes were
measured at the end of 6 weeks -Kupferberg endoscopic staging, Absolute
Eosinophilic Count (AEC), Serum Immunoglobulin (IgE), and Sino Nasal
Outcome Test - 20 scores. Results Our study showed no statistical
significance in outcomes between the two groups treated with
Itraconazole and Methylprednisolone regarding recurrence, AEC, IgE, and
Quality of Life Assessment (p<0.01). Conclusion Itraconazole
was comparable to Methylprednisolone in preventing disease recurrence in
the post-operative management of AFRS. It may be a viable alternative to
replacing systemic steroids where the latter may be contraindicated.
Itraconazole given at a dose of 400 mg once daily for six weeks was a
safe dose. Keywords: Allergic Fungal Rhinosinusitis, Itraconazole,
endoscopy, Quality of Life, Methylprednisolone Key points: •
Itraconazole was comparable to systemic steroid (Methylprednisolone) in
preventing disease recurrence in the post-operative management of AFRS.
• It may be a viable alternative to replacing systemic steroids where
the latter may be contraindicated. • Itraconazole given at a dose of 400
mg once daily for six weeks was a safe dose. • Recurrence may be treated
safely with Itraconazole than with steroids. • The course may be
repeated in case of recurrence with close monitoring.