The Effect of the Oral Itraconazole on the Management of Allergic Fungal Sinusitis
Soheila Nikakhlagh1, Ali Khodadai2, Malek Kanani3, Lila sistani karampour4, Nader Saki5*

1Soheila Nikakhlagh, Hearing and Speech research center, Ahvaz Jundishapur University of Medical Sciences 2Ali Khodadai, Cancer research center, Ahvaz Jundishapur University of Medical Sciences 3Malek Kanani, Cancer research center, Ahvaz Jundishapur University of Medical Sciences 4Lila sistani karampour, Hearing and Speech research center, Ahvaz Jundishapur University of Medical Sciences 5Nader Saki, Hearing and Speech research center, Ahvaz Jundishapur University of Medical Sciences

Abstract: Allergic fungal rhinosinusitis (AFS) is the most common form of fungal sinus disease. Its recurrence rate is high despite numerous strategies to prevent it. Oral itraconazole is an antifungal agent that seems to be benefit to the patients with AFS. Because management of allergic fungal sinusitis after surgery is difficult and prolonged steroid use has significant side effects and there are a group of patients who are unresponsive to standard treatment. So this study was designed to compare the outcome of AFS after addition of oral itraconazol to the treatment protocol. This Prospective randomized controlled clinical study done on 57 patients who were diagnosed with AFS by clinical, radiologic, histopathologic, and laboratory workup and who subsequently underwent Functional Endoscopic Sinus Surgery (FESS). Postoperatively, these patients were randomized into two treatment groups matched for sex, age, and socioeconomic status. Systemic and topical nasal steroids with (group A) or without (group B) oral itraconazole ( 100 mg b.i.d)  for at least 2 months was used postoperatively. 7 patients didn`t follow up their treatment so 25 cases of group A continued to follow up. The data obtained were analyzed statistically using descriptive Statistics and report results base on tables and figures. 11 patients of group A had endoscopic and radiological improvement and this improvement was maintained during the follow up period, while 5 had radiologic evidence of recurrence of sinus within 6 months, 7 patients had recurring polyp in one or both sides and two  patients had to stop treatment after two months due to abnormal liver function tests. Mean pretreatment IgE was 876 microgram/L and posttreatment IgE was 754 microgram/L. 16 patients (64%) of group B (control group) had recurring polyp in one or both sides, while 3 (12%) had radiologic evidence of recurrence of sinus and nasal polyps within 6 months, 6 patients had endoscopic and radiological improvement and this improvement was maintained during the follow up period. Mean follow up time was 12.4 months. oral Itraconazole may be of benefit as an adjunct in the management of refractory AFS. It may prolong the time of recurrence. But Steroids continue to remain the mainstay of treatment and more research is needed to define the role of systemic antifungal drugs.

Keywords: Oral Itraconazole; Allergic Fungal Sinusitis; Steroid; FESS  

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