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The role of doxycycline in the management of chronic rhinosinusitis with nasal polyps.
- Source :
-
American journal of otolaryngology [Am J Otolaryngol] 2019 Jul - Aug; Vol. 40 (4), pp. 467-472. Date of Electronic Publication: 2019 Mar 04. - Publication Year :
- 2019
-
Abstract
- Introduction: Many theories on the pathophysiology of chronic rhinosinusitis with nasal polyposis (CRSwNP) exist. The most effective management of CRSwNP has not been elucidated. Doxycycline, which has anti-inflammatory and anti-bacterial properties, has shown durable effects; however, its efficacy in combination with standard therapy has not been examined. We hypothesized that its addition to the standard anti-inflammatory regimen would improve patient outcomes.<br />Methods: We performed a double-blind, placebo-controlled trial at a tertiary level institution. Patients with moderate or severe CRSwNP were randomized into two groups, each receiving a 20-day course of oral corticosteroids and doxycycline or placebo. The 22-item Sinonasal Outcome Test (SNOT-22), nasal polyp scores, and visual analog scale (VAS) scores were recorded at the initial, 3-, 8- and 12-week visits.<br />Results: 49 patients were enrolled, 24 in the experimental and 25 in the placebo group with 3 moderate disease patients in each group. There were 12 dropouts in the treatment group and 14 in the placebo group. The most common reasons for dropout were severe CRS and asthma exacerbations. There was no significant difference in SNOT-22 scores, nasal polyp scores, and VAS scores between the two arms.<br />Conclusions: Non-surgical management of patients with CRSwNP remains challenging. Our conclusions are limited given the high dropout rate and thus, limited sample size with inadequate power. This study is important, however, because a high dropout rate of mostly severe disease patients may illustrate that this patient population may not be optimally managed with medical therapy alone.<br /> (Copyright © 2019. Published by Elsevier Inc.)
- Subjects :
- Administration, Oral
Adult
Chronic Disease
Double-Blind Method
Drug Therapy, Combination
Female
Humans
Male
Methylprednisolone administration & dosage
Middle Aged
Severity of Illness Index
Treatment Outcome
Doxycycline administration & dosage
Nasal Polyps complications
Paranasal Sinuses
Sinusitis complications
Sinusitis drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1532-818X
- Volume :
- 40
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- American journal of otolaryngology
- Publication Type :
- Academic Journal
- Accession number :
- 31126631
- Full Text :
- https://doi.org/10.1016/j.amjoto.2019.03.004