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Non-steroid, non-antibiotic anti-biofilm therapy for the treatment of chronic rhinosinusitis: a systematic review

Published online by Cambridge University Press:  05 March 2021

A Taylor ,
J Fuzi ,
A Sideris ,
C Banks  and
T E Havas
A Taylor*
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, Prince of Wales Hospital, Sydney, Australia Department of Otolaryngology–Head and Neck Research Group, Prince of Wales Hospital, Sydney, Australia Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
J Fuzi
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, Prince of Wales Hospital, Sydney, Australia Department of Otolaryngology–Head and Neck Research Group, Prince of Wales Hospital, Sydney, Australia Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
A Sideris
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, Prince of Wales Hospital, Sydney, Australia Department of Otolaryngology–Head and Neck Research Group, Prince of Wales Hospital, Sydney, Australia Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
C Banks
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, Prince of Wales Hospital, Sydney, Australia Department of Otolaryngology–Head and Neck Research Group, Prince of Wales Hospital, Sydney, Australia
T E Havas
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, Prince of Wales Hospital, Sydney, Australia Department of Otolaryngology–Head and Neck Research Group, Prince of Wales Hospital, Sydney, Australia Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
*
Author for correspondence: Dr Alon Taylor, Department of Otolaryngology–Head and Neck Surgery, Outpatients A, Prince of Wales Hospital, Barker St, Randwick2031, Australia. E-mail: alon.taylor@health.nsw.gov.au
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Abstract

Objective

Chronic rhinosinusitis patients with biofilms cultured from their sinonasal cavity have greater symptom burden and risk of recalcitrant disease. A number of non-antibiotic, ‘anti-biofilm’ treatments exist which show anti-biofilm properties in preclinical studies. There is little evidence evaluating their impact on clinical symptom scores in chronic rhinosinusitis.

Method

A systematic review was performed to assess the literature regarding the efficacy of non-steroid, non-antibiotic, anti-biofilm specific topical therapies in the treatment of chronic rhinosinusitis. The primary outcome assessed was change in validated patient reported outcome measures before and after anti-biofilm treatment.

Results

Thirteen studies assessing the effect of anti-biofilm therapies in chronic rhinosinusitis through validated patient-reported outcome measures were included. Seven different anti-biofilm specific therapies for chronic rhinosinusitis were identified. None of the seven anti-biofilm therapies was identified as being confidently efficacious beyond placebo. Only one therapy (intranasal xylitol) showed a statistically significant reduction in symptom scores compared with placebo in more than one trial.

Conclusion

Robust evidence supporting the use of various anti-biofilm therapies in chronic rhinosinusitis is lacking. Further high quality, human, in vivo trials studying the effect of anti-biofilm therapies in chronic rhinosinusitis are needed to address the deficiencies of the current evidence base.

Keywords

Anti-Bacterial AgentsTherapeutic UseBiofilmsDrug EffectsChronic DiseaseHumansRhinitisSinusitisSurface-Active AgentsTreatment Outcome
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 3 , March 2021 , pp. 196 - 205
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr A Taylor takes responsibility for the integrity of the content of the paper

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