Tolerability and effectiveness of povidone-iodine or mupirocin versus saline sinus irrigations for chronic rhinosinusitis.
Adult
Anti-Bacterial Agents
/ therapeutic use
Anti-Infective Agents, Local
Chronic Disease
Female
Humans
Male
Middle Aged
Mupirocin
/ therapeutic use
Postoperative Complications
/ diagnosis
Povidone-Iodine
/ therapeutic use
Prospective Studies
Rhinitis
/ diagnosis
Saline Solution
Single-Blind Method
Sinusitis
/ diagnosis
Therapeutic Irrigation
Anti-infective agents
Endoscopy
Microbiota
Quality of life
Sino-nasal outcome test
Sinusitis
Therapeutic irrigation
Journal
American journal of otolaryngology
ISSN: 1532-818X
Titre abrégé: Am J Otolaryngol
Pays: United States
ID NLM: 8000029
Informations de publication
Date de publication:
Historique:
received:
04
05
2020
accepted:
31
05
2020
pubmed:
22
6
2020
medline:
4
9
2020
entrez:
22
6
2020
Statut:
ppublish
Résumé
The role of topical anti-infectives in acute exacerbations of chronic rhinosinusitis is controversial. Povidone-iodine is an anti-bacterial and anti-viral that is affordable and available over-the-counter and may demonstrate advantages over mupirocin as a sinus irrigation therapy. The objective was to compare povidone-iodine or mupirocin versus saline sinus irrigations for sinusitis exacerbations in post-surgery subjects as well as to assess tolerability of povidone-iodine sinus irrigations. This was a prospective single-blinded (clinician only) randomized controlled trial. Subjects were post-surgery with acute exacerbations of chronic rhinosinusitis and gram-positive bacteria on culture. They received povidone-iodine, mupirocin, or saline sinus irrigations, twice daily for 30 days. Outcomes were post-treatment culture negativity (primary) and Sinonasal Outcome Test-20 and Lund-Kennedy endoscopic score change (secondary). Of the 62 subjects analyzed, post-treatment culture negativity rate was higher in the MUP (14/20, 70%) group compared to the PI (9/21, 43%) and SAL (9/19, 47%) groups, although this was not significant (p = 0.29). Povidone-iodine sinus irrigations at the 1% concentration were very well-tolerated, similar to saline irrigations. There were no significant differences in Sinonasal Outcome Test-20 score (povidone-iodine -0.3 [-0.6, 0.05] vs. mupirocin -0.3 [-0.7, 0.05] vs. saline -0.4 [-0.8, 0.05]; p = 0.86) or Lund-Kennedy endoscopic score (povidone-iodine -3.5 [-7, -0.5] vs. mupirocin -2 [-4, 2] vs. saline -3 [-5, 0]; p = 0.45) change. No serious adverse effects were reported. In patients who have had prior sinus surgery with acute exacerbations of CRS and gram-positive bacteria on culture, mupirocin sinus irrigations achieved a better post-treatment culture "control" rate compared to saline and povidone-iodine. In addition, 1% povidone-iodine solution was well-tolerated as a sinus irrigation and may represent a feasible method for temporarily disinfecting the sinonasal cavity of bacteria and viruses such as COVID-19.
Identifiants
pubmed: 32563787
pii: S0196-0709(20)30298-2
doi: 10.1016/j.amjoto.2020.102604
pmc: PMC7484091
mid: NIHMS1605389
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Anti-Infective Agents, Local
0
Saline Solution
0
Povidone-Iodine
85H0HZU99M
Mupirocin
D0GX863OA5
Types de publication
Comparative Study
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
102604Subventions
Organisme : NIDCD NIH HHS
ID : T32 DC000018
Pays : United States
Commentaires et corrections
Type : ErratumIn
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest None.
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