PDF(Pubmed)
Abstract：
OBJECTIVE: This narrative review explores alternative non-antibiotic antimicrobial agents for CRS management in adults.
METHODS: Alternative antimicrobial agents using EPOS 2020 guidelines as reference were selected, and articles dated from 2003 to 2022 in English, Portuguese, or Spanish using PubMed and EMBASE databases. The parameters analyzed included study design, evidence level, population characteristics, CRS characteristics, interventions, outcomes, sample size, randomization, blinding, and side effects. Reviews, unrelated contexts,in vitro experiments, and duplicates were excluded.
RESULTS: 148 articles were screened; 19 articles were selected for analysis. Randomized controlled trials and cohort studies assessing non-antibiotic antimicrobial treatments for CRS were included. Xylitol demonstrated effectiveness in reducing CRS symptoms, particularly SNOT-22 scores, surpassing saline irrigation benefits. Manuka honey showed potential microbiological benefits in recalcitrant CRS, but symptomatic and endoscopic improvements remained inconclusive. Baby shampoo irrigation improved nasal mucociliary clearance and postoperative outcomes. Colloidal silver nasal irrigation showed limited efficacy in reducing CRS symptoms or endoscopic scores. Povidone-Iodine (PI) nasal irrigation yielded mixed results, with varying effects on culture negativity and SNOT-20 scores. Bacteriophage treatment exhibited promise in decreasing specific bacterial strains and cytokine levels.
CONCLUSIONS: Non-antibiotic antimicrobial therapies, including xylitol, manuka honey, baby shampoo, colloidal silver, PI, bacteriophages, lactoferrin, and carrageenan offer potential alternatives for CRS in adult patients. Xylitol, baby shampoo, and PI presented benefits in improving symptoms and nasal endoscopic scores, however, the number of studies is limited for conclusive recommendations and safety assessments. CRS management should adopt a comprehensive approach, particularly for non-infectious or immune-related cases, moving beyond antibiotics. Antibiotics should be reserved for confirmed bacterial infections. Overall, this review shows the importance of exploring non-antibiotic therapies to enhance the management of CRS.
METHODS: Alternative antimicrobial agents using EPOS 2020 guidelines as reference were selected, and articles dated from 2003 to 2022 in English, Portuguese, or Spanish using PubMed and EMBASE databases. The parameters analyzed included study design, evidence level, population characteristics, CRS characteristics, interventions, outcomes, sample size, randomization, blinding, and side effects. Reviews, unrelated contexts,in vitro experiments, and duplicates were excluded.
RESULTS: 148 articles were screened; 19 articles were selected for analysis. Randomized controlled trials and cohort studies assessing non-antibiotic antimicrobial treatments for CRS were included. Xylitol demonstrated effectiveness in reducing CRS symptoms, particularly SNOT-22 scores, surpassing saline irrigation benefits. Manuka honey showed potential microbiological benefits in recalcitrant CRS, but symptomatic and endoscopic improvements remained inconclusive. Baby shampoo irrigation improved nasal mucociliary clearance and postoperative outcomes. Colloidal silver nasal irrigation showed limited efficacy in reducing CRS symptoms or endoscopic scores. Povidone-Iodine (PI) nasal irrigation yielded mixed results, with varying effects on culture negativity and SNOT-20 scores. Bacteriophage treatment exhibited promise in decreasing specific bacterial strains and cytokine levels.
CONCLUSIONS: Non-antibiotic antimicrobial therapies, including xylitol, manuka honey, baby shampoo, colloidal silver, PI, bacteriophages, lactoferrin, and carrageenan offer potential alternatives for CRS in adult patients. Xylitol, baby shampoo, and PI presented benefits in improving symptoms and nasal endoscopic scores, however, the number of studies is limited for conclusive recommendations and safety assessments. CRS management should adopt a comprehensive approach, particularly for non-infectious or immune-related cases, moving beyond antibiotics. Antibiotics should be reserved for confirmed bacterial infections. Overall, this review shows the importance of exploring non-antibiotic therapies to enhance the management of CRS.
摘要：
目的：这篇叙述性综述探讨了成人CRS管理的替代非抗生素抗菌药物。
方法：选择使用EPOS2020指南作为参考的替代抗菌药物，以及2003年至2022年的英文文章，葡萄牙语,或使用PubMed和EMBASE数据库的西班牙语。分析的参数包括研究设计，证据水平,人口特征，CRS特性,干预措施，结果，样本量,随机化，盲法,和副作用。评论,不相关的上下文，体外实验，并排除重复项。
结果：共筛选了148篇文章；选择了19篇文章进行分析。纳入评估非抗生素抗微生物治疗CRS的随机对照试验和队列研究。木糖醇在减少CRS症状方面表现出有效性，特别是SNOT-22的分数，超越盐水灌溉的好处。麦卢卡蜂蜜在顽固性CRS中显示出潜在的微生物益处，但症状和内镜下的改善仍无定论.婴儿洗发水冲洗改善鼻黏膜纤毛清除和术后预后。胶体银鼻腔冲洗在减少CRS症状或内窥镜评分方面显示出有限的功效。聚维酮-碘（PI）鼻腔冲洗产生混合结果，对文化消极情绪和SNOT-20得分有不同的影响。噬菌体治疗在降低特定细菌菌株和细胞因子水平方面显示出希望。
结论：非抗生素抗菌治疗，包括木糖醇,manuka蜂蜜,婴儿洗发水,胶体银，PI,噬菌体,乳铁蛋白,和角叉菜胶为成人患者的CRS提供了潜在的替代方案。木糖醇,婴儿洗发水,PI在改善症状和鼻内镜评分方面表现出益处，然而,结论性建议和安全性评估的研究数量有限.CRS管理应采取综合办法,特别是对于非传染性或免疫相关病例，超越抗生素抗生素应保留用于确认的细菌感染。总的来说,这篇综述显示了探索非抗生素疗法以加强CRS管理的重要性.
方法：选择使用EPOS2020指南作为参考的替代抗菌药物，以及2003年至2022年的英文文章，葡萄牙语,或使用PubMed和EMBASE数据库的西班牙语。分析的参数包括研究设计，证据水平,人口特征，CRS特性,干预措施，结果，样本量,随机化，盲法,和副作用。评论,不相关的上下文，体外实验，并排除重复项。
结果：共筛选了148篇文章；选择了19篇文章进行分析。纳入评估非抗生素抗微生物治疗CRS的随机对照试验和队列研究。木糖醇在减少CRS症状方面表现出有效性，特别是SNOT-22的分数，超越盐水灌溉的好处。麦卢卡蜂蜜在顽固性CRS中显示出潜在的微生物益处，但症状和内镜下的改善仍无定论.婴儿洗发水冲洗改善鼻黏膜纤毛清除和术后预后。胶体银鼻腔冲洗在减少CRS症状或内窥镜评分方面显示出有限的功效。聚维酮-碘（PI）鼻腔冲洗产生混合结果，对文化消极情绪和SNOT-20得分有不同的影响。噬菌体治疗在降低特定细菌菌株和细胞因子水平方面显示出希望。
结论：非抗生素抗菌治疗，包括木糖醇,manuka蜂蜜,婴儿洗发水,胶体银，PI,噬菌体,乳铁蛋白,和角叉菜胶为成人患者的CRS提供了潜在的替代方案。木糖醇,婴儿洗发水,PI在改善症状和鼻内镜评分方面表现出益处，然而,结论性建议和安全性评估的研究数量有限.CRS管理应采取综合办法,特别是对于非传染性或免疫相关病例，超越抗生素抗生素应保留用于确认的细菌感染。总的来说,这篇综述显示了探索非抗生素疗法以加强CRS管理的重要性.
