Chronic Sinusitis, Fungal Infection is the cause in over 93% of cases

Drug Selection Amphotericin B and Compounding Options

Chronic Sinusitis is the most common chronic disease that is refractory to treatment. In fact one out of every seven Americans suffer from chronic sinusitis.(1)

Nasal polyps are often associated with chronic sinusitis.

In 1999 Mayo clinic researchers studied 210 patients and found that the cause of 93% of chronic Rhinosinusitis is due to allergic fungal sinusitis (AFS) a delayed immune reaction to fungi. They identified 40 different varieties of fungi in these patients and an average of 2.7 types per patient (2).

ï¿½This is a potential breakthrough that offers great hope for the millions of people who suffer from this problemï¿½, said Dr. Eugene Kern of the Mayo Clinic. We can now begin to treat the cause of the problem instead of the symptoms. These finding may also help to explain why antibiotics are often not effective for chronic sinusitis.

Treatment

Amphotericin B compounded nasal solution   (twice daily each nostril for 6 months)

3. Richetti et al    74 patients with I,II or III nasal polyposis. Total disappearance of nasal polyps were seen in 39% with amphotericin B nasal solution.

4. Ponikau et el 51 patients with chronic rhinosinusitis. Open study.   Improvement of sinusitis in 75% of patients (39 patients ). Endoscopically 35% of patients were disease free. No effect in 25% of patients

5. Ponikau et al Radomized double blind controlled trial 30 Patients with Chronic Rhinusitis treated with amphtericin B intranasally or placebo saline. 24 patients completed the 6 months of treatment.
Results Reduction of mucosal thickening in amphotericin b ( group minus 8.8%) vs plus 2.5% in placebo group. Similarly there were beneficial changes in endoscopic examination, inflammatory markers (eosinophil infiltration) in the treated group versus worsening in all domains in the placebo group.

1. Clin Exp allergy 1996 May 26 Suppl 3 23-30
2. Mayo clinic Proc 1999 Sept74(9):877-84
3. J Laryngol Otol 2002 April 116(4):261-3
4. J Allergy Clin Immunol 110(6): 862-6 2002
5. J Allergy Clin Immunol 115(1): 125-31 2005

There are a number of other options over the counter and by prescription that can be compounded that can treat chronic sinusitis.

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