Antibiotic concentrations in the sinonasal secretions and tissue in CRS patients after oral therapy: a randomized trial

Show simple item record Siu, Joey Klingler, Lilian Wang, Yi Hung, Cheung-Tak Jeong, Soo Hee Smith, Susan Tingle, Malcolm Mackenzie, Brett Wagner Biswas, Kristi Douglas, Richard 2022-05-03T02:31:28Z 2022-05-03T02:31:28Z 2020-06-18
dc.identifier.citation bioRxiv 18 Jun 2020,158535-.
dc.description.abstract <h4>Background</h4> Despite the widespread prescription of antibiotics for patients with chronic rhinosinusitis (CRS), the extent to which drug distribution to the sinonasal mucosa influences their efficacy remains largely undefined. <h4>Methods</h4> Thirty subjects undergoing functional endoscopic sinus surgery (FESS) for bilateral CRS were randomized to one of three groups: 1) doxycycline (100 mg daily for seven days) 2) roxithromycin (300 mg daily for seven days) and 3) control (no antibiotics given). Drug levels were measured using liquid chromatography-tandem mass spectrometry in sinonasal secretions, sinonasal tissues and serum at steady state. Nasal endoscopy (Modified Lund-Kennedy) and Gastrointestinal Symptom Rating Scale (GSRS) scores were recorded. <h4>Results</h4> Antibiotic concentrations in the nasal secretions were significantly lower compared to those in the serum and tissue (mean mucus/serum ratio at steady state = 0.16 and 0.37 for doxycycline and roxithromycin respectively; p <0.01). A short course of antibiotic intake did not correlate with any difference in clinical outcomes except where slightly higher GSRS scores were reported in the roxithromycin group ( p =0.04). <h4>Conclusions</h4> Although the efficacy of doxycycline and roxithromycin in sinonasal mucus in vivo cannot be predicted solely from reported minimum inhibitory concentrations, given the added complication of bacterial biofilm antimicrobial tolerance, these results suggest that low mucosal penetration of antibiotics may be one of the factors contributing to the limited efficacy of these agents in the treatment of CRS.
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher.
dc.subject Clinical Research
dc.subject Infectious Diseases
dc.subject Emerging Infectious Diseases
dc.subject 6.1 Pharmaceuticals
dc.subject Infection
dc.title Antibiotic concentrations in the sinonasal secretions and tissue in CRS patients after oral therapy: a randomized trial
dc.type Journal Article
dc.identifier.doi 10.1101/2020.06.17.158535
pubs.begin-page 2020.06.17.158535 2022-04-04T22:12:49Z
dc.rights.holder Copyright: The author en
pubs.publication-status Published
dc.rights.accessrights en
pubs.subtype Preprint
pubs.elements-id 876192 Medical and Health Sciences Medical Sciences Pharmacology School of Medicine Surgery Department
pubs.record-created-at-source-date 2022-04-05

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