Systemic methylprednisolone as adjunct is effective in chronic rhinosinusitis
Published Online: May 31, 2011
Symptoms of chronic rhinosinusitis (CRS) may not always improve despite treatment with antibiotics, and inflammation often persists where corticosteroids may have a therapeutic role. However, there is no evidence on the effect of systemic corticosteroids as anti-inflammatory agents in the treatment of children with CRS.
In a recent issue of The Journal of Allergy and Clinical Immunology (JACI), Ozturk et al assessed for the first time the effectiveness of oral methylprednisolone (MP) as an adjunct to antibiotics in the treatment of 48 children and adolescents with CRS without nasal polyposis in a double-blind placebo controlled study. Patients were given oral amoxicillin/clavulanate (AMX/C) twice daily for 30 days together with either oral MP or placebo (P) for the first 15 days with a tapering schedule. Mean change in symptom and sinus computed tomography (CT) scan scores after treatment, tolerability and relapse rate for 6-months were monitored. Forty-five patients (22 AMX/C and MP, 23 AMX/C and P) completed the study.
Both groups demonstrated significant improvements in symptom and sinus CT scores, compared to baseline (p<0.001). Methylprednisolone as an adjunct was more effective than placebo in reducing total rhinosinusitis symptoms (p=0.001), CT scores (p=0.004), and the incidence of clinical relapses (25 % in MP group, 43% in P, p = 0.137). Treatment-related adverse events were similar between the groups. Short-term oral MP seems to provide added benefit to treatment with antibiotics for children with CRS.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.