背景:鼻腔微生物群是慢性鼻-鼻窦炎(CRS)炎症过程的主要环境因素。抗生素和类固醇是CRS治疗的支柱。然而,它们对微生物群落的影响需要更好地理解。本系统综述总结了有关抗生素和类固醇对CRS患者鼻腔微生物群影响的证据。
方法:检索策略按照PRISMA系统评价指南进行。作者搜索了三个主要医学数据库(PubMed,Scopus,和Cochrane图书馆)使用PICO工具(人口,干预,比较,和结果)。使用关键术语“微生物群”或“微生物群”和“慢性鼻-鼻窦炎”的组合进行搜索。
结果:总体而言,402篇论文被确认,并且在重复删除后(127篇论文),不包括偏离主题的论文(154)和其他结构性原因(110),论文被评估为合格;最后,本系统综述仅纳入并总结了11篇论文.一些作者只使用类固醇,其他研究人员只使用抗生素,其他人同时使用抗生素和类固醇。关于使用类固醇作为独家医疗,研究了局部莫米松和布地奈德.关于使用抗生素作为唯一的医疗方法,克拉霉素,多西环素,罗红霉素,和阿莫西林克拉维酸进行了调查。关于抗生素和类固醇的使用,研究了两种相关性:全身性泼尼松联合阿莫西林克拉维酸和外用布地奈德联合阿奇霉素.
结论:治疗对CRS患者鼻腔微生物组的影响是多种多样的。需要进一步的研究来了解鼻腔微生物组的作用,防止CRS,并改进针对个体患者量身定制的个性化医疗的治疗工具。
BACKGROUND: The nasal microbiome represents the main environmental factor of the inflammatory process in chronic rhinosinusitis (CRS). Antibiotics and steroids constitute the mainstay of CRS therapies. However, their impact on microbial communities needs to be better understood. This systematic
review summarizes the evidence about antibiotics\' and steroids\' impact on the nasal microbiota in patients with CRS.
METHODS: The search strategy was conducted in accordance with the PRISMA guidelines for systematic reviews. The authors searched all papers in the three major medical databases (PubMed, Scopus, and Cochrane Library) using the PICO tool (population, intervention, comparison, and outcomes). The search was carried out using a combination of the key terms \"Microbiota\" or \"Microbiome\" and \"Chronic Rhinosinusitis\".
RESULTS: Overall, 402 papers were identified, and after duplicate removal (127 papers), excluding papers off-topic (154) and for other structural reasons (110), papers were assessed for eligibility; finally, only 11 papers were included and summarized in the present systematic
review. Some authors used only steroids, other researchers used only antibiotics, and others used both antibiotics and steroids. With regard to the use of steroids as exclusive medical treatment, topical mometasone and budesonide were investigated. With regard to the use of antibiotics as exclusive medical treatments, clarithromycin, doxycycline, roxithromycin, and amoxicillin clavulanate were investigated. Regarding the use of both antibiotics and steroids, two associations were investigated: systemic prednisone combined with amoxicillin clavulanate and topical budesonide combined with azithromycin.
CONCLUSIONS: The impact that therapies can have on the nasal microbiome of CRS patients is very varied. Further studies are needed to understand the role of the nasal microbiome, prevent CRS, and improve therapeutic tools for personalized medicine tailored to the individual patient.