An International Journal Clinical Rhinology

Register      Login

VOLUME 4 , ISSUE 1 ( January-April, 2011 ) > List of Articles

RESEARCH ARTICLE

Should Voriconazole be the Primary Therapy for Chronic Invasive Sinus Aspergillosis (CISA)?

Keywords : Amphotericin B,Chronic invasive sinus aspergillosis,Treatment,Voriconazole

Citation Information : Should Voriconazole be the Primary Therapy for Chronic Invasive Sinus Aspergillosis (CISA)?. Clin Rhinol An Int J 2011; 4 (1):21-26.

DOI: 10.5005/jp-journals-10013-1065

Published Online: 00-04-2011

Copyright Statement:  Copyright © 2011; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction

Invasive sinus aspergillosis infection has been reported with increasing frequency in the last decade, especially, in immunocompromised patients with chronic invasive sinus aspergillosis (CISA). The gold standard for treatment has been wide surgical debridement, intravenous administration of antifungal agents, such as amphotericin B, but the prognosis remains poor. Newer antifungal agents are being tried but no standard treatment option with new antifungal agents has yet been established for chronic invasive fungal sinusitis. Therefore, we undertook this study to evaluate the efficacy of voriconazole in patients of chronic invasive sinus aspergillosis.

Materials and methods

This study is a prospective randomized unblinded study with primary aim of evaluating the feasibility and effectivity of voriconazole in patients of chronic invasive sinus aspergillosis with intraorbital or intracranial extension, and secondarily to compare voriconazole with amphotericin B therapy in patients with chronic invasive sinus aspergillosis.

Observations and results

Thirty-three patients who fulfilled the eligibility criteria were included in this study. There were 18 patients enrolled in group I who received amphotericin therapy and 15 patients in group II who received voriconazole therapy. Out of 33 patients, 9 patients had complete response, 10 had partial response, in eight patients disease became stable and there were seven failures. Overall 50% patients had a successful outcome in group I, whereas 60% had a successful outcome in group II receiving oral voriconazole. On comparing only in extradural group, 5/10 had a successful outcome in group I receiving amphotericin B, whereas 8/12 (66.7%) had a successful outcome in group 2 receiving voriconazole. There was significant difference between adverse reactions of the two drugs, with amphotericin B having a significant renal and cardiotoxicity as compared to voriconazole; though patients on voriconazole developed skin rashes which were transient and disappeared on completion of the therapy.

Conclusion

The present series demonstrates that oral voriconazole can be the primary line of therapy in chronic invasive sinus aspergillosis in carefully monitored immunocompetent cases. Multicentric, randomized studies are required to define disease definition, duration and successful outcome.


PDF Share
  1. Craniocerebral aspergillosis of sinonasal origin in immunocompetent patients: Clinical spectrum and outcome in 25 cases. Neurosurgery 2004;55:602-11.
  2. Invasive aspergillosis. Clin Infect Dis 1998;26:781-803.
  3. Chronic invasive sinus aspergillosis in immunocompetent hosts: A geographic comparision. Mycopathologica Dec 2010;170(6):403-10.
  4. Fungal Rhinosinusitis: Diagnosis and therapy. Curr allergy Asthma Rep 2001;1:268-76.
  5. New investigational triazole agents for the treatment of invasive fungal infections. J Chemother 2008;20:661-71.
  6. Fungal sinusitis. N Engl J Med 1997;337:254-59.
  7. A new classification and diagnostic criteria for invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 1997;123:1181-88.
  8. Rhinocerebral aspergillosis. J Laryngol Otol 1992;106:981-85.
  9. Chronic invasive aspergillosis of the paranasal sinuses in immunocompetent hosts from Saudi Arabia. Am J Trop Med Hyg 2001;65:83-86.
  10. Intracranial Invasive aspergillosis: Can a combined modality approach result in superior patient outcome? Clinical Rhinology 2008;1(1):1-5.
  11. Invasive sinus aspergillosis in apparently immunocompetent hosts. J Infect 1998;37:229-40.
  12. Chronic fungal sinusitis in apparently normal hosts. Medicine 1988;67:231-47.
  13. Prevalence of airborne Aspergillus flavus in khartoum (Sudan) airspora with reference to dusty weather and inoculum survival in simulated summer conditions. Myco- pathologia 1988;104:137-41.
  14. Airborne viable, non-viable, and allergenic fungi in a rural agricultural area of India: A 2-year study at five outdoor sampling stations. Sci Total Environ 2004;326:123-41.
  15. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis N Eng J Med 2002; 347:408-15.
  16. Successful treatment of invasive sinusitis with caspofungin and voriconazole. Ear Nose Throat J 2008; 87:30-33.
  17. Invasive sphenoidal aspergillosis: Successful treatment with sphenoidotomy and voriconazole. ORL J Otorhinol Relat Spec 2007;68:121-26.
  18. Posaconazole for treatment of refractory invasive fungal disease. Mycoses 2006;49(Suppl 1):37-41.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.