[Effectiveness of topical antibiotic therapy in the prevention of infectious and inflammatory complications after rhinosurgical interventions].

Abstract

Optimization of postoperative management of patients after rhinosurgery does not lose its relevance. A significant therapeutic and economic aspect is the rational prescription of systemic antibacterial therapy after conditionally clean operations. This issue is especially acute today, in conditions of the rapid formation of multiresistance in pathogens, the growth of allergic sensitization to medical substance and the comorbidity of patients. The need to have clear criteria for prescribing local and/or systemic antibacterial therapy after surgical interventions in the nasal cavity and paranasal sinuses in order to prevent infectious complications is beyond doubt.

Objective: To assess the effectiveness and safety of the use of topical antibacterial medication in patients after rhinosurgery.

Material and methods: 60 patients (38 were men and 22 women) aged 18 to 55 years were observed in the Clinic of Ear, Nose and Throat Diseases of the Sechenov First Moscow State Medical University, who underwent surgery under general anesthesia for non-purulent pathology of the nasal cavity and paranasal sinuses. In the postoperative period, all patients were randomly divided into two groups: the main group, which received Isofra (framecitin sulfate) intranasally, 1 dose 4 times a day for 5 days, and the control group, in which the antibiotic ceftriaxone was administered intramuscularly 1.0 g 2 times a day at the same time. In order to compare the indicators in the two groups on the 1st, 3rd and 5th days after surgery, the severity of subjective and objective symptoms was assessed using visual analogue scales (VAS). All observed patients were discharged from the hospital on the 5th day after surgery; on the 10th day, on an outpatient basis, material was collected from the mucous membrane of the nasal cavity for microbiological and cytological examination and the rate of mucociliary transport (MCT) was assessed using a saccharin test. For 3 months after discharge, all patients were called by a doctor monthly to identify episodes of acute respiratory viral infections, including the development of bacterial complications.

Results: Statistically significant differences were recorded on the 5th day after surgery in terms of the severity of nasal obstruction (p<0.05) - in the main group, the degree of difficulty in nasal breathing was lower than in the control group. There were no significant differences in the results of microbiological and cytological studies, or MCT indicators; the results of the main and control groups were comparable. No adverse events were observed in patients during topical antibiotic therapy; during systemic antibacterial treatment, 3 patients experienced dyspeptic symptoms for 3-7 days.

Conclusion: Thus, the antibacterial nasal spray Isofra, when used in the postoperative period, is not inferior in effectiveness to preventive systemic antibacterial therapy, which allows, taking into account the risk of the formation of resistant strains of microorganisms and the development of adverse events against the background of systemic antibacterial therapy, to significantly limit the indications for the latter.