Combination therapy in the treatment of acute rhinosinusitis, including intranasal glucocorticosteroids and phytotherapy.

Abstract

Acute sinusitis (AS) is a rapid-onset inflammation of the nasal mucosa andparanasal sinuses. In about 98-99% of cases, AS is caused by viral infections,most commonly by rhinoviruses, coronaviruses, parainfluenza viruses, influenzaviruses, and adenoviruses. Bacterial superinfections occur in only about 1% ofviral infections. The widespread overuse of antibiotics for this usually self-limitingdisease has contributed significantly to the global problem of antibiotic resistance.Accordingly, treatment guidelines strongly promote symptomatic treatmentand therapies that target the underlying inflammation and pathophysiology.This review examines the evidence for the efficacy of two classes of drugs asrecommended in the EPOS 2020 guidelines: intranasal corticosteroids (INCS) andthe plant-based medicinal product BNO 1016. The analysis encompassed different mechanisms of action of both agents, high-quality clinical evidence supporting their efficacy and safety, and the benefitsof combination therapy using both drugs. An analysis and comparison were made of the roles of both agents in moderntherapeutic strategies in AS. While INCS offer potent, targeted anti-inflammatory activity, BNO 1016 offers a multimodalapproach by combining secretolytic, anti-inflammatory, and antimicrobial properties. Both agents are key evidence--based alternatives to antibiotics to be used in line with the principles of responsible antibiotic therapy.