Wednesday, October 3, 2012

Local therapy of acute rhinosinusitis in children

Local therapy of acute rhinosinusitis in children

In many cases, antibiotics are the drugs of choice for acute rhinosinusitis in children. However, they are associated with significant drawbacks, such as the growing prevalence of resistance and, because of this, a reduced efficacy; furthermore, such treatments do not fully remove the pathological content from these patients’ paranasal sinuses.

Another risk commonly associated with the administration of antibiotics in these cases is premature discontinuation of the treatment due to the clear symptom improvement but before the normal treatment cycle has been completed (which increases the risk of recurrence of the disease and appearance of resistance). On other occasions, as Professor Bogomilskiy pointed out, “we see antibiotics being used in situations of acute viral or fungal rhinosinusitis.”



All of these limitations of antibiotic therapy can lead to particularly dramatic events, such as the chronification of the disease process and/or frequent relapses.
The treatment of acute paediatric rhinosinusitis is usually started by the GP or the paediatrician. In the speaker’s opinion, “this is a problem, as it should be the otorhinolaryngologists who prescribe the appropriate treatment. Neither the GPs nor the paediatricians have appropriate endoscopic resources nor do they know the anatomo-physiological details of the otorhinolaryngological organs, which increases the risk of orbital and intracranial complications in these patients (the dangers posed by acute rhinosinusitis are underestimated).”


Local therapies 
Local therapies in acute rhinosinusitis offer significant benefits although a series of requirements must be met in order to optimise their results. It is necessary to create optimal conditions for drainage of the paranasal sinuses, the cavities must be emptied naturally (although sometimes it is necessary to use surgery), steps should be taken to promote mucociliary activity, the purulent content must be removed by puncture or other methods, greater use should be made of physiotherapy and, in some cases, iontophoresis.

Creating the necessary conditions for drainage of the paranasal sinuses
  • Opening the natural exits, sometimes by surgery
  • Clearing the ciliary epithelium of the nasal mucosa
  • Expelling the contents by puncture and other methods
  • Physiotherapy
  • Iontophoresis

In this context, as the speaker assured, “preparations that facilitate drainage of the nasal passages, such as Nasodren®, are particularly attractive.” This product’s active ingredient has a unique mechanism of action and shows major differences compared with other local therapies routinely used in acute rhinosinusitis; this preparation stimulates secretions thanks to its irritant effect on mucous membrane glands. Given this unique mechanism of action, a number of recommendations should be taken into account when using cyclamen extract. In children with acute rhinosinusitis, it is particularly important to clear the nasal meatus, especially in paediatric patients who are still too young to blow their nose correctly by themselves; before administering cyclamen extract, it is necessary to clear the nasal passages. In some cases (acute purulent rhinosinusitis), it is advisable to combine the cyclamen extract with systemic antibacterial therapy. However, as the speaker explained, “these are not drawbacks of Nasodren®, but simply advice that should be followed to improve the outcome and avoid possible adverse effects.”
The main limitation described to date with the use of cyclamen extract in children is due to its stimulant effect on the nasal passages, “but this is a very minor drawback if one considers that this is a treatment and we are achieving significant benefits from its use. It is without doubt a safe product that is not associated with persistent negative consequences in paediatric patients; there are no contraindications to its use in children over 5 and we have not observed any hypersensitivity reactions to the preparation in our studies.”

Take it from: II Round Table, New horizons in the treatment of acute and chronic rhinosinusitis.Prof. M. Bogomilskiy Moscow. Russia


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