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No5-6(3) 2020

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DOI 10.37219/2528-8253-2020-6-49
Al Hariri MJ, Koshel IV, Popovych VI
Clinical and microbiological parallels of delayed prescribing of antibiotics in patients with acute rhinosinusitis
Al Hariri Mahmoud Joumaa
Ivano-Frankivsk National Medical University
postgraduate student of Otorhinolaryngology, Ophthalmology with a course of head and neck surgery.
https://orcid.org/0000-0002-8669-7026

Koshel Ivanna V.
Ivano-Frankivsk National Medical University
Doctor of Medicine, Assistant Professor of Therapy and Family Medicine Department.
https://orcid.org/0000-0002-5466-4537

Popovich Vasil I.
Ivano-Frankivsk National Medical University
Doctor of Medicine, Professor, Head of Otorhinolaryngology, Ophthalmology Department with a course of head and neck surgery.
E-mail: popovychvasyl@gmail.com
https://orcid.org/0000-0002-2898-8474

Abstract

Topicality: The rate of acute bacterial rhinosinusitisis 0,5-2% of all cases of acute rhinosinusitis, however, up to 60 % of patients receive the course of antibiotics since the first day of disease. It is well known that earlier use of antibiotics has almost no effect on the development of bacterial ARS and its complications.
The purpose of study was to examine the bacterial spectrum of post-viral RS and evaluate clinical and bac-teriological efficiency of polyvalent bacteriophage in technique of delayed prescribing of antibiotics in comparison with the patients receiving standard APVRS therapy.
Material and methods: 155 adult patients with acute post-viral RS participated in the trial who were given either standard therapy or polyvalent bacteriophage in addition to the standard therapy. In conjunction with the treatment, the microbiological composition of nasal microflora was examined and its comparison with clinical dynamics was undertaken. Evaluation criteria: decrease in intensity of disease symptoms evaluated in accordance with MSS scale system during each visit in comparison with the 1st visit, antibiotic prescribing frequency, dynamics of microbiological changes.
Outcomes and discussion: The use of polyvalent bacteriophagein addition to the standard therapy of acute post-viral rhinosinusitis as a part of technique of delayed prescribing of antibioticsensures clinically significant decrease in the intensity of rhinorrhea symptoms, nasal congestion and post-nasal drip on the third day of supervision (p<0.05). It reduces the prescription of antibacterial medicines by 20%without negative impact on overall treatment results. Decrease in the number of prescription of antibacterial therapy correlates with the fair reduction in bacterial loadwith Staphylococcus aureus and typical representative of ABRS – S. pneumoniae, Haemophilus influenza and M. catarrhalis. Therefore, the intervention group in comparison with the control group has had “therapeutic advantage” during the first days of treatment which allowed to assess the course of disease as a “positive” and avoid in appropriate use of antibiotics. There have been documented no patients with adverse effects during the course of treatment.
Conclusion: polyvalent bacteriophage is a safe and effective medication for additional treatment of acute post-viral rhinosinusitis intended to reduce the use of antibiotics. The inclusion of the medication into the treatment regimen could be recommended to the patients as a part of technique of delayed prescribing of antibiotics.

Keywords

acute rhinosinusitis, polyvalent bacteriophage, delayed antibiotic therapy.


Reference

  1. Fokkens W, Lund V, Bachert C, Clement P, Helllings P, Holmstrom M, et al. EAACI position paper on rhi-nosinusitis and nasal polyps executive summary. Allergy. 2005;60(5):583-601. DOI: 10.1111/j.1398-9995.2005.00830.
  2. Hoffmans R, Wagemakers A, van Hellings P, Fokkens W. Acute rhinosinusitis and allergic rhinitis to comor-bidity, ethnicity and environment.
    PLoS One. 2018 Feb 5;13(2):e0192330. doi: 10.1371/journal.pone.0192330.
  3. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012 Mar;50(1):1-12. doi:10.4193/Rhino50E2.
  4. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. Clinical practice guideline (update): Adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152(4):598-609. doi: 10.1177/0194599815574247.
  5. Koskinen A, Numminen J, Markkola A, Karjalainen J, Karstila T, Seppдlд M, et al. Diagnostic Accuracy of Symptoms, Endoscopy, and Imaging Signs of Chronic Rhinosinusitis Without Nasal Polyps Compared to Allergic Rhinitis. Am J Rhinol Allergy. 2018 May;32(3):121-131.
    doi: 10.1177/1945892418762891.
  6. Seresirikachorn K, Snidvongs K, Chitsuthipakorn W, Ruksakul W, Chusakul S, Kanjanaumporn J, et al. EPOS2012 has bet¬ter specificity compared to
    IDSA2012 for diagnosing acute bacterial rhinosinusitis. Rhinology 2018 Sep 1;56(3):241-244. doi: 10.4193/Rhin17.261.
  7. Jaume F, Quintу L, Alobid I, Mullol J. Overuse of diagnostic tools and medications in acute rhinosinusitis in Spain: a population-based study (the PROSINUS study). BMJ open 2018 Jan 31;8(1):e018788. doi: 10.1136/bmjopen-2017-018788.
  8. Stjдrne P, Odebдck P, Stдllberg B, Lundberg J, Olsson P. High costs and burden of illness in acute rhinosinusitis: real-life treatment patterns and outcomes in Swedish prima¬ry care. Primary Care Respiratory Journal 2012 Jun; 21(2): 174–179. doi: 10.4104/pcrj.2012.00011.
  9. Babar-Craig H, Gupta Y, Lund VJ. British Rhinological Society audit of the role of antibiotics in complications of acute rhinosinusitis: a national prospective audit. Rhinology 2010;48:344-7. doi: 10.4193/Rhin09.130.
  10. Hansen FS, Hoffmans R, Georgalas C, Fokkens WJ. Complications of acute rhinosinusitis in the Netherlands. Fam Pract 2011;29:147-53.
    doi:10.1136/bmj.g5703.
  11. Stoll D, Klossek JM, Barbaza MO. [Prospective study of 43 severe complications of acute rhinosinusitis]. Rev Laryngol Otol Rhinol (Bord)
    2006;127:195-201. doi: org/10.1007/978-3-54068940-9. [Article in French].
  12. Fokkens W, Lund V, Mullol J, Bachert C,Cohen N, Cobo R, et al. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl.
    2007:1-136. doi: 10.4193/rhino50e2.
  13. Eloy P, Poirrier AL, De Dorlodot C, Van Zele T, Watelet JB, Bertrand B. Actual concepts in rhinosinusitis: a review of clinical presentations inflammatory pathways, cytokine profiles, remodeling, and management. Curr Allergy Asthma Rep. 2011;11:146-62. doi: 10.1007/s11882-011-0180-0.
  14. Tan KS, Yan Y, Ong HH, Chow VTK, Shi L, Wang D-Y. Impact of Respiratory Virus Infections in Exacerbation of Acute and Chronic Rhinosinusitis. Curr Allergy Asthma Rep. 2017;17:24. doi: 10.3389/fcell.2020.00099.
  15. Masood A, Maoumoulidis I, Panesar J. Acute rhinosinusitis in adults: an update on current management. Postgrad Med. 2007;83:402–8.
    doi:10.1136/pgmj.2006.054767.
  16. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020. Suppl. 29: 1-464. doi: org/10.4193/Rhin20.600.
  17. Gwaltney JM, Jr, Hendley JO, Phillips CD, Bass CR, Mygind N, Winther B. Nose blowing propels nasal fluid into the paranasal sinuses. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2000 Feb;30(2):387-91. doi:10.1086/313661.
  18. Payne SC, Benninger MS. Staphylococcus aureus is a major pathogen in acute bacterial rhinosinusitis: a metaanalysis. Clinical infectious diseases:
    an official publication of the Infectious Diseases Society of America. 2007 Nov15;45(10):e121-7.doi:org/10.1371/journal.pone.0009452.
  19. Brook I. Bacteriology of acute and chronic frontal sinusitis. Archives of otolaryngology – head & neck surgery. 2002 May;128(5):583-5.
    doi:10.1001/archotol.128.5.583.
  20. Van Cauwenberge P, Ingels K. Effects of viral and bacterial infection on nasal and sinus mucosa. Acta Oto-laryngol. 1996 Mar;116(2):316-21.
    doi: 10.3109/00016489609137849.
  21. Morozova V, Vlassov V, Tikunova N. Applications of Bacteriophages in the Treatment of Localized Infections in Humans. Front Microbiol. 2018 Aug
    2;9:1696. doi: 10.3389/fmicb.2018.01696.
  22. Sultanov NM. [Antibacterial activity and clinical efficiency of the medicine polyvalent pyobacteriophage refined for treatment of chronic purulent rhinosinusitis] [dissertation]. Ufa. 2007; 25 p. [In Russian].
  23. Weber-Dabrowska B, Zimecki M, Kruzel M, Kochanowska I, Lusiak-Szelachowska M. Alternative therapies in antibiotic-resistant infection. Advances in Medical Sciences. 2006;51:242-4. doi: 10.37219/2528-8253-2018-1-51.
  24. Al Hariri Mahmoud Jоmaa, Semenenko SI, Zaikov SV, Popovich VI. Application of bacteriophage in complex treatment of rinosinusites. Otorhinolaryngology. 2018;1(1):51-4. [Article in Ukrainian].
  25. Unified clinical protocol of primary, secondary (specilised) and tertiary (highly-specialised) medical assistance “[Acute Rhinosinusitis]”. Available from: http://mtd.dec.gov.ua/images/dodatki/2016_85_GRS/2016_85_YKPMD_GRS.pdf. [In Ukrainian].
 

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