xRead - Nasal Obstruction (September 2024) Full Articles

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Orlandi et al.

(Continues)

Recommendation against: Should generally not be

prescribed for CRSwNP except in acute exacerbations

Strong recommendation against: Topical antifungals are not

recommended for CRSs/wNP

Option: Macrolides are likely beneficial in CRSwNP.

Optimal drug, dosage, and

treatment duration are not known

Topical antibiotics are not

recommended for CRSs/wNP

Option: Macrolides are an option for patients with CRSsNP. Optimal drug, dosage, and treatment duration are not known

Recommendation against:

Benefit-Harm Assessment Policy Level

harm over benefits

Minimal risk of harm but no apparent

potential for benefit

Relative harm over benefit

Low Benefits appear to outweigh harm

Low Benefits appear to outweigh harm

Variable Preponderance of

Moderate

Moderate to High

Lowto

Intervention Grade Benefit Harm Cost

GI upset, skin rash, insomnia, and

headache; See Table II-1. Potential delay of more effective interventions Nasal congestion,

irritation, epistaxis and

headache less common

Gastrointestinal side effects, ototoxicity, hepatotoxicity,

cardiotoxicity, and

drug-drug interactions; See Table II-1.

irritation, epistaxis.

Theoretical possibility

of systemic absorption aminoglycosides.

Possibility of bacterial resistance

Gastrointestinal side effects, ototoxicity, hepatotoxicity,

cardiotoxicity, and

drug-drug interactions; See Table II-1.

Potential for local

B(-) Potential reduction in polyp size with

doxycycline without

change in symptoms

A(-) No apparent benefit from use of topical antifungals

B May improve symptom and endoscopic scores in CRSwNP.

Macrolides appear to be comparable to INCS in selected patients

A(-) Systematic reviews and RCTs failed to show

benefit from the use

of topical antibiotics inCRS

endoscopy and

symptom scores

B Reduction in

TABLE I-4 (Continued)

Non-Macrolide Antibiotics ( < 3weeks)

CRSs/wNP: Topical Antifungals

CRSsNP: Macrolide Antibiotics

CRSwNP: Macrolide Antibiotics

CRSs/wNP: Topical Antibiotics

CRSwNP: