Acute rhinusinusitis is mainly initiated by viral infections. Bacterial infection is usually superadded. The inflammatory cascade upregulates the pro-inflammatory mediators resulting in pain, nasal obstruction and nasal discharge. Local application of steroids and antibiotics could provide a higher concentration of these agents at the affected site and there are lesser side-effects compared to use of systemic anitibiotics. With these concepts, the authors carried out a randomised, controlled and prospective study on 40 patients presenting with acute rhinusinusitis, one group receiving topical steroids (dexamethsone 0.053%) with topical antibiotic (ofloxacin 0.26%) and the other group receiving only oral antibiotic (amoxicillin 90mg/kg). The control of symptoms was assessed with a questionnaire using VAS, eight, 24 and 48 hours after initiation of therapy and finally on the tenth day. Using statistical analysis, it was noted that pain was initially better controlled in the topical therapy group. This was also the case with nasal discharge. Nasal obstruction was equally reduced in both groups initially. After ten days, nasal discharge lingered a bit more in the topical therapy group. Control of bacterial presence was also assessed by taking swabs on the first and tenth day, but results of this do not seem to be conclusive. The authors contend that in cases of uncomplicated rhinusinusitis, topical therapy including steroids is relatively more effective. It is not clear whether these patients were hospitalised, because otherwise eight and 24 hourly observations could be onerous. If hospitalised, these patients might as well have received intravenous antibiotics to make hospitalisation worthwhile.

Comparative study of the efficacy of topical steroid and antibiotic combination therapy versus oral antibiotic alone when treating acute rhinusinusitis.
El-Hennawi DM, Ahmed MR, Farid AM, Al-Murtadah AM.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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