Oral Itraconazole in the Treatment of Chronic Rhinosinusitis

RATIONALE: We conducted a retrospective cohort study to determine the clinical efficacy of oral itraconazole treatment in patients with chronic rhinosinusitis (CRS).METHODS: Patients with physician-diagnosed CRS and sinus CT consistent with CRS and treated with oral itraconazole 200 mg once a day or twice daily from June 2005 to April 2006 were enrolled into the study. Charts were reviewed for symptoms, sinus CT, presence of nasal polyps by endoscopy, blood eosinophilia, and itraconazole treatment efficacy. A univariate logistic regression analysis was employed to determine whether symptoms, presence of nasal polyps, and blood eosinophilia predicted efficacy to itraconazole. P < 0.05 was considered statistically significant.RESULTS: Forty-eight subjects were enrolled (mean age of 52 ± 12 years; 25 males and 23 females) among whom 31(65%) had nasal polyps. The most common symptoms were nasal obstruction [40(83%)], postnasal drainage [25(52%)], and hypo/anosmia [25(52%)]. The most common treatments before itraconazole were sinus surgery (92%), antibiotics (81%), and intranasal steroid (69%). After itraconazole treatment, 30 (70%) of 43 subjects reported an improvement in their symptoms. Patients with nasal polyps were more likely to improve on itraconazole compared to those without nasal polyps [22/27 (81%) vs. 8/16 (50%) p=0.03, respectively]. Six of 48 patients had sinus CTs before and after treatment, and all 6 showed improvement. Blood eosinophilia was observed in 25% of patients, but it did not affect treatment outcomes.CONCLUSIONS: Oral itraconazole may be an effective treatment for CRS in patients with nasal polyps. A larger placebo-controlled study is needed to confirm these findings. RATIONALE: We conducted a retrospective cohort study to determine the clinical efficacy of oral itraconazole treatment in patients with chronic rhinosinusitis (CRS). METHODS: Patients with physician-diagnosed CRS and sinus CT consistent with CRS and treated with oral itraconazole 200 mg once a day or twice daily from June 2005 to April 2006 were enrolled into the study. Charts were reviewed for symptoms, sinus CT, presence of nasal polyps by endoscopy, blood eosinophilia, and itraconazole treatment efficacy. A univariate logistic regression analysis was employed to determine whether symptoms, presence of nasal polyps, and blood eosinophilia predicted efficacy to itraconazole. P < 0.05 was considered statistically significant. RESULTS: Forty-eight subjects were enrolled (mean age of 52 ± 12 years; 25 males and 23 females) among whom 31(65%) had nasal polyps. The most common symptoms were nasal obstruction [40(83%)], postnasal drainage [25(52%)], and hypo/anosmia [25(52%)]. The most common treatments before itraconazole were sinus surgery (92%), antibiotics (81%), and intranasal steroid (69%). After itraconazole treatment, 30 (70%) of 43 subjects reported an improvement in their symptoms. Patients with nasal polyps were more likely to improve on itraconazole compared to those without nasal polyps [22/27 (81%) vs. 8/16 (50%) p=0.03, respectively]. Six of 48 patients had sinus CTs before and after treatment, and all 6 showed improvement. Blood eosinophilia was observed in 25% of patients, but it did not affect treatment outcomes. CONCLUSIONS: Oral itraconazole may be an effective treatment for CRS in patients with nasal polyps. A larger placebo-controlled study is needed to confirm these findings.