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Orlandi et al.

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TABLE X-31 Evidence for AFRS management with oral antifungal therapy Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Head 618 2018 1 Systematic review CRS patients N/A Studies including AFRS is lacking Verma 1732 2017 2 Non blinded Prospective T AFRS patients undergoing ESS: 4 weeks itraconazole preop then surgery (n = 25) 4 weeks itraconazole postop (N = 100) No itraconazole (N = 50) SNOT20 Lund Mackay Nasal endoscopy score Preop and postop itraconazole showed significant improvement in SNOT, LM and endoscopy scores. Preop itraconazole showed better results compared to postop but similar recurrence rate. Khalil 1735 2011 2 Non-blinded

considered an effective

treatment alternative to steroids.

Recurrence rates in the 5 groups were 66.7, 10.0, 14.3, 28.6, and 75.0%, respectively (no

stastical analysis was done)

Preoperative itraconazole reduced hyperdensity

in postop CT, improved polyp size and nasal endoscopy score.

Reduction in postop fungal culture in

itraconazole arm.

Itraconazole can be

Recurrence rate (not clearly defined)

Eosinophil count SerumIgE SNOT22

SNOT-20

Nasal endoscopy score Lund Mackay

AFRS patients recruited preoperatively and meds started

immediately post ESS:

1. Prednisolone 30 mg QD 1 month followed by topical steroid

2. Oral itraconazole 6 months

5. Conventional medical therapy only

AFRS patients undergoing sinus surgery 1. Oral itraconazole 1 month pre-op

AFRS patients:

1. Oral itraconazole

2. Fluconazole nasal spray 3. Combined (1) and (2)

4. Fluconazole irrigation

2. No pre-op treatment

non-randomized control

prospective RCT (not placebo controlled)

Prospective case control

Patro 1734 2015 3 Randomized

Rojita 1733 2017 3 Prospective