The role of itraconazole in recalcitrant fungal sinusitis

Background: Oral itraconazole is an antifungal that has been shown to be of benefit to patients with allergic bronchopulmonary aspergillus (ABPA). It is hypothesized that itraconazole may similarly benefit patients with allergic fungal sinusitis (AFS), a disease similar to ABPA. This study was designed to evaluate the therapeutic response of itraconazole in patients with refractory chronic fungal sinusitis who have failed maximal medical and surgical therapy. Methods: A retrospective chart review was performed of 23 patients with AFS and nonallergic eosinophilic fungal sinusitis treated with oral itraconazole. Charts were reviewed for patient demographics, comorbidities, allergies, fungal cultures, type of surgery performed, and amount of oral steroids used before and after itraconazole. All patients were given a 6-month dose of itraconazole (100 mg b.i.d.) when recurrence developed after surgery. Time to next recurrence, change in oral steroid use, and outcomes Were noted. Liver function tests were taken at monthly intervals while on itraconazole. Results: Twenty-three patients, 13 men and 10 women, were started on oral itraconazole for recurrent fungal sinusitis. Nineteen patients responded to the medication with a decrease in symptoms and fungal mucin/polyps on endoscopy. Three patients had to stop because of elevated liver enzymes. In the remaining 16 patients a decrease in oral steroid use was noted. In addition, 11 of the 16 patients are disease free to date at a mean follow-zip of 15.7 months. No permanent complications occurred from the use of the medication. Conclusion: Oral itraconazole may be of benefit to those patients with recalcitrant fungal sinusitis who have failed maximal medical and surgical therapy. Itraconazole may prolong the time to next recurrence and may enable the patient to significantly decrease or stop oral steroids. (Am J Rhinol Allergy 23, 303-306, 2009; doi: 10.2500/ajra.2009.23.3315)