Oral Itraconazole as an Adjunct to Steroids in AFRS

Abstract

Objective: To evaluate itraconazole therapy in allergic fungal rhinosinusitis.

Method: Prospective randomized study in 75 cases of allergic fungal rhinosinusitis. The subjects were randomized to 2 groups. All the patients were subjected to endoscopic sinus surgery. The specimen was analyzed for mycological profile and histopathological characteristics. Those assigned to group A were given oral steroids and those in group B were given oral steroids and itraconazole for 3 months. These patients underwent follow-up examination at 6 weeks, 12 weeks, and 24 weeks with postoperative nasal endoscopic examination and computerized tomography. Random blood sugar estimation and liver function tests were done to watch for side effects. Ten patients were lost to follow-up during the study period. Hence statistical analysis was done in 65 patients; 39 subjects in group A and 26 in group B.

Results: Fungal smear was positive in 84.6% of subjects. Aspergillus flavus was commonly isolated. Patients receiving adjunct itraconazole therapy had a better cavity healing at 12-24 weeks of follow-up compared to those receiving steroids (P = .027). Patients with intraorbital extension had lesser chance of recurrences on oral itraconazole compared to steroids (P = .018). Itraconazole therapy was found to be beneficial in recalcitrant cases (P = .050). No side effects were observed with itraconazole.

Conclusion: Itraconazole as an adjunct to corticosteroids has no advantage at 6 months of follow-up. However, it results in better cavity healing. Itraconazole was found to be beneficial in preventing recurrences in recalcitrant cases and patients with intraorbital extension.