类固醇鼻喷雾剂加速鼻窦炎康复

可能可提高抗生素、抗鼻塞剂等常规疗法的疗效

  12月26日出版的美国医学会杂志中报导的一项研究发现,类固醇鼻喷雾剂应作为复发的急性,或慢性鼻窦炎患者的推荐治疗方法。

  第一作者Rowena Dolor医师任职于达拉谟杜克大学医学中心,她在记者会上说:「因为复发的慢性鼻窦炎更难治疗,因此,我们的目标是,在观察在常规抗生素疗法的基础上,辅以鼻内给予皮质类固醇治疗是否有效。」

  在这项双盲的、多中心的研究中,从1998年10月到2000年4月期间,招募95名患有复发性,或慢性鼻窦炎的成年患者,他们的X光或内视镜检查发现有急性感染的迹象。病人被随机分为fluticasone组或安慰剂组,每个鼻孔喷雾给药,连续给药21天;同时给予抗鼻塞药xylometazolime喷雾剂,每天给药2次,连续3天,以及抗生素cefuroxime喷雾剂,每天给药2次,连续10天。

  88名患者完成追纵调查,fluticasone组在治疗第三天症状改善,明显快于安慰剂组,fluticasone组,93%的患者,病况治愈或鼻窦炎症状明显改善,安慰剂,组仅为74%。

  Dolor认为,更为迅速的症状改善,能使劳动人口的生产力得到提高。尽管,研究存在著局限性,比如,没有经由培养物区分细菌或病毒感染,她仍建议急性复发性鼻窦炎,或慢性鼻窦炎急性发作时,应包括鼻内给予皮质类固醇治疗。

  尽管,没有关于严重不良反应的报导,但fluticasone组,存在著发生更多不良反应的趋势。

  该项研究由fluticasone和cefuroxime的制造厂GlaxoSmithKline赞助。

Steroid Nasal Spray Hastens Sinusitis Recovery

May Improve Standard Treatment With Antibiotics, Decongestants

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Dominique Walton Brooks, MD, MBA

Dec. 26, 2001 -- Steroid nasal sprays should be part of a recommended treatment regimen for patients with recurrent episodes of acute rhinosinusitis or chronic sinusitis, based on a study reported in the Dec. 26 issue of The Journal of the American Medical Association.

"Because recurrent and chronic sinus disease is more difficult to treat, our goal was to examine the benefits of adding an intranasal corticosteroid to standard antibiotic therapy," lead author Rowena Dolor, MD, MHS, from Duke University Medical Center in Durham, N.C., said in a news release.

In this double-blind, multicenter trial, 95 adults with a history of recurrent or chronic sinusitis and X-ray or endoscopic evidence of an acute infection were recruited from October 1998 through April 2000. Patients were randomized to treatment with two puffs of fluticasone (Flonase) or placebo in each nostril for 21 days, along with two puffs of the decongestant xylometazoline hydrochloride twice daily for three days and the antibiotic cefuroxime axetil (Ceftin) twice daily for 10 days.

Eighty-eight patients completed follow-up. Patients on fluticasone had their symptoms improve an average of three days faster than patients receiving placebo, and 93% on fluticasone reported a cure or significant improvement of sinus problems, compared to only 74% on placebo.

More rapid improvement should allow greater productivity in working populations, according to Dolor. Despite study limitations such as lack of cultures to distinguish bacterial from viral infection, she recommends that expert guidelines for acute recurrent or chronic rhinosinusitis include intranasal corticosteroids in the therapeutic regimen.

Although there were no serious adverse effects reported, there was a trend toward more adverse events in the fluticasone group.

GlaxoSmithKline, maker of fluticasone and cefuroxime, funded and supplied the medication for the study.

© 2001 WebMD Corporation. All rights reserved.

    
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