Wie ist die Evidenzlage bei der nicht-antibiotischen medikamentösen Therapie der Rhinosinusitis?

 

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Zusammenfassung

Hintergrund:

Vor dem Hintergrund einer umfangreichen Literaturrecherche zur Überprüfung der S2-AWMF-Leitlinie zur Rhinosinusitis und Polyposis nasi soll in diesem systematischen Review die Frage beantwortet werden, inwiefern anhand neuerer klinischer Studien neue Empfehlungen gegeben werden können oder bestehende Empfehlungen sich bestätigen lassen oder verändert werden müssen.

Material und Methoden:

Es wurde eine breit angelegte systematische Literaturrecherche in PUBMED, MEDLINE und diversen Datenbanken über MEDPILOT, und im Cochrane Central Register of Controlled Trials bis einschließlich 09/2010 durchgeführt. Die aus den Suchergebnissen durch 2 Reviewer ausgewählten relevanten klinischen Studien wurden anhand einer erweiterten Jadad-Skala hinsichtlich ihrer methodischen Qualität beurteilt und in Blick auf Studiendesign, Therapeutikum/Anwendung, Kontrollgruppe und Ergebnisse ausgewertet. Für die einzelnen Therapeutika wurden Evidenzlevel bestimmt.

Ergebnisse:

Aus 1 346 Abstracts wurden 227 möglicherweise geeignete Originalarbeiten im gesamten Publikationszeitraum identifiziert; 47 thematisch passende Originalarbeiten wurden ab 01/2006 publiziert und für diese Übersichtsarbeit berücksichtigt. Nach Analyse der neuen klinischen Studien und Berücksichtigung aktueller systematischer Reviews können bisherige Empfehlungen zur Sinusitistherapie weitgehend beibehalten werden.

Schlussfolgerung:

Die Evidenzlevel für die topische Steroidtherapie bei akuter und chronischer Rhinosinusitis liegen bei Ia. Es gibt neue Hinweise für den Nutzen einer Anwendung von Salzlösungen nicht nur bei chronischer sondern auch bei akuter Rhinosinusitis. Neuere Therapieansätze werden untersucht, können aber aufgrund bisher ungenügender Evidenz noch nicht empfohlen werden.

Abstract

What is the Evidence for Non-Antibiotic Drug Therapy of Rhinosinusitis?

Background:

The German AWMF-guideline for rhinosinusitis and nasal polyps is to be reassessed. By searching the literature for the reevaluation we investigate in this systematic review to what extent existing recommendations can be affirmed, have to be changed or if there are new recommendations to give.

Material and Methods:

We searched PUBMED, MEDLINE and other databases via MEDPILOT, and the Cochrane Central Register of Controlled Trials without limiting the publication date range. Relevant clinical trials identified by 2 reviewers out of the search results were assessed for their methodical quality using an extended Jadad scale. Datas were extracted and study design, therapy/application, control group and results were analysed. Furthermore, levels of evidence for the different therapeutics have been determined.

Results:

Out of 1 346 search results 227 potentially eligible trials were identified; for this review we considered only the 47 trials published since 01/2006. Former recommendations are mainly supported by the identified relevant publications and several Cochrane reviews published in the last years.

Conclusions:

Levels of evidence are Ia for topical and systemic corticosteroid therapy for acute and chronic rhinosinusitis. Additionally, there is evidence that the application of saline solutions is useful not only for chronic but also for acute rhinosinusitis. New therapy options are under examination, but there is not enough evidence for adding them to actual recommendations.

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