medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-16-96-100medsovet-2138Research ArticleШкола оториноларингологаSchool otorhinolaryngologyТЕРАПИЯ РИНОСИНУСИТА: НАСТОЯЩЕЕ И БУДУЩЕЕRHINOSINUSITIES THERAPY: PRESENT AND FUTUREШиленковаВ. В.ShilenkovaV. V.

Доктор медицинских наук,  профессор

MD, Prof.

Ярославский государственный медицинский университетРоссияYaroslavl State Medical UniversityRussian Federation20170811201701696100Copyright © Шиленкова В.В., 20172017Шиленкова В.В.Shilenkova V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2138

В статье представлены аспекты медикаментозной терапии риносинуситов с  точки зрения патогенеза заболевания. Показано, в каких случаях требуется назначение системной антибактериальной терапии, обоснован выбор оптимального антибиотика с учетом современной ситуации с антибиотикорезистентностью и чувствительностью. Автор приводит данные одного из последних исследований, в котором доказано, что чувствительность пневмококка  и гемофильной  палочки к амоксициллину и амоксициллин/клавуланату составляет 100%, что определяет их назначение в качестве препаратов первой линии терапии острого бактериального риносинусита и обострения хронического риносинусита. В статье содержится информация о клинических исследованиях  последних лет и новых тенденциях медикаментозного лечения хронического риносинусита с применением интраназальных глюкокортикостероидов, антилейкотриеновых препаратов и моноклональных антител.

The article presents the aspects of medical therapy of rhinosinusitis from the point of view of the disease pathogenesis. It is shown in which cases the indication of a systemic antibacterial therapy, the choice of optimal antibiotic given the current situation with antibiotic resistance and sensitivity is required. The author cites one recent study, which proved that the sensitivity of pneumococcus and Haemophilus influenzae to amoxicillin and amoxicillin/clavulanate is 100%, which defines their indication as first-line drugs for treatment of acute bacterial rhinosinusitis and acute exacerbation of chronic rhinosinusitis. The article provides information about clinical research in recent years and new trends of medical treatment of chronic rhinosinusitis with the use of corticosteroids, antileukotriene drugs and monoclonal antibodies.

риносинуситамоксициллинАмосин®rhinosinusitisamoxicillinAmosin®ReferencesFokkens WJ, Lund VJ, Mullol J et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinology, 2012, 50(23): 1-298.Fokkens WJ, Lund VJ, Mullol J et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinology, 2012, 50(23): 1-298.Chow AW, Benninger MS, Brook I et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin. Infect. Dis., 2012, 54(8): 72-112. doi: 10.1093/cid/cir1043.Chow AW, Benninger MS, Brook I et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin. Infect. Dis., 2012, 54(8): 72-112. doi: 10.1093/cid/cir1043.Guo R, Canter PH, Ernst E. Herbal medicines for the treatment of rhinosinusitis: a systematic review. Otolaryngol Head Neck Surg, 2006, 135: 496-506. doi: 10.1016/j.otohns.2006.06.1254.Guo R, Canter PH, Ernst E. Herbal medicines for the treatment of rhinosinusitis: a systematic review. Otolaryngol Head Neck Surg, 2006, 135: 496-506. doi: 10.1016/j.otohns.2006.06.1254.Blin P, Blazejewski S, Lignot S, Lassalle R, Bernard MA, Jayles D et al. Effectiveness of antibiotics for acute sinusitis in real-life medical practice. Br. J. Clin. Pharmacol., 2010, 70(3): 418-428.Blin P, Blazejewski S, Lignot S, Lassalle R, Bernard MA, Jayles D et al. Effectiveness of antibiotics for acute sinusitis in real-life medical practice. Br. J. Clin. Pharmacol., 2010, 70(3): 418-428.Стратегия и тактика рационального применения антимикробных средств в амбулаторной практике: Евразийские клинические рекомендации. Под ред. С.В. Яковлева, С.В. Сидоренко, В.В. Рафальского, Т.В. Спичак. М.: Пре100 Принт, 2016: 144.Стратегия и тактика рационального применения антимикробных средств в амбулаторной практике: Евразийские клинические рекомендации. Под ред. С.В. Яковлева, С.В. Сидоренко, В.В. Рафальского, Т.В. Спичак. М.: Пре100 Принт, 2016: 144.Feshchenko Y, Dzyublik A, Pertseva T, Bratus E, Dzyublik Y, Gladka G, Morrissey I, Torumkuney D. Results from the Survey of Antibiotic Resistance (SOAR) 2011–2013 in Ukraine. J. Antimicrob Chemother, 2016, 71(l): 63-69. doi:10.1093/jac/dkw068.Feshchenko Y, Dzyublik A, Pertseva T, Bratus E, Dzyublik Y, Gladka G, Morrissey I, Torumkuney D. Results from the Survey of Antibiotic Resistance (SOAR) 2011–2013 in Ukraine. J. Antimicrob Chemother, 2016, 71(l): 63-69. doi:10.1093/jac/dkw068.Autio TJ, Koskenkorva T, Leino TK, Koivunen P, Alho OP. Longitudinal analysis of inflammatory biomarkers during acute rhinosinusitis. Laryngoscope, 2017, 127(2): 55-61. doi: 10.1002/ lary.26344.Autio TJ, Koskenkorva T, Leino TK, Koivunen P, Alho OP. Longitudinal analysis of inflammatory biomarkers during acute rhinosinusitis. Laryngoscope, 2017, 127(2): 55-61. doi: 10.1002/ lary.26344.Unuvar E, Tamay Z, Yildiz I, Toprak S, Kilic A, Aydin S, Kilic G, Guler N, Oguz F, Sidal M. Effectiveness of erdosteine, a second generation mucolytic agent, in children with acute rhinosinusitis: a randomized, placebo controlled, double-blinded clinical study. Acta Paediatr, 2010, 99(4): 585-589. doi: 10.1111/j.1651-2227.2009.01646.x.Unuvar E, Tamay Z, Yildiz I, Toprak S, Kilic A, Aydin S, Kilic G, Guler N, Oguz F, Sidal M. Effectiveness of erdosteine, a second generation mucolytic agent, in children with acute rhinosinusitis: a randomized, placebo controlled, double-blinded clinical study. Acta Paediatr, 2010, 99(4): 585-589. doi: 10.1111/j.1651-2227.2009.01646.x.Passali D, Spinosi MC, Crisanti A, Bellussi LM. Mometasone furoate nasal spray: a systematic review. Multidiscip Respir Med, 2016, 11: 18. doi: 10.1186/s40248-016-0054-3.Passali D, Spinosi MC, Crisanti A, Bellussi LM. Mometasone furoate nasal spray: a systematic review. Multidiscip Respir Med, 2016, 11: 18. doi: 10.1186/s40248-016-0054-3.Гущин И.С., Ильина Н.И., Польнер С.А. Аллергический ринит: методическое пособие. М., 2002. 68 с.Гущин И.С., Ильина Н.И., Польнер С.А. Аллергический ринит: методическое пособие. М., 2002. 68 с.Wiklund L, Stierna P, Berglund R, Westrin KM, Tönnesson M. The efficacy of oxymetazoline administered with a nasal bellows container and combined with oral phenoxymethyl-penicillin in the treatment of acute maxillary sinusitis. Acta Otolaryngol, 1994, 515: 57-64.Wiklund L, Stierna P, Berglund R, Westrin KM, Tönnesson M. The efficacy of oxymetazoline administered with a nasal bellows container and combined with oral phenoxymethyl-penicillin in the treatment of acute maxillary sinusitis. Acta Otolaryngol, 1994, 515: 57-64.Graf P. Rhinitis medicamentosa: a review of causes and treatment. Treat Respir Med, 2005, 4: 21-29.Graf P. Rhinitis medicamentosa: a review of causes and treatment. Treat Respir Med, 2005, 4: 21-29.Passali D, Salerni L, Passali GC, Passali FM, Bellussi L. Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use. Expert Opin Drug Saf, 2006, 5: 783-790. doi: 10.1517/14740338.5.6.783.Passali D, Salerni L, Passali GC, Passali FM, Bellussi L. Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use. Expert Opin Drug Saf, 2006, 5: 783-790. doi: 10.1517/14740338.5.6.783.Lockey RF. Rhinitis medicamentosa and the stuffy nose. J Allergy Clin Immunol, 2006, 118: 1017-1018. doi:10.1016/j.jaci.2006.06.018.Lockey RF. Rhinitis medicamentosa and the stuffy nose. J Allergy Clin Immunol, 2006, 118: 1017-1018. doi:10.1016/j.jaci.2006.06.018.Hastan D, Fokkens WJ, Bachert C, Newson RB, Bislimovska J et al. Chronic rhinosinusitis in European underestimated disease. A GA(2)LEN study. Allergy, 2011, 66: 1216-1223. doi:10.1111/j.1398-9995.2011.02646.x.Hastan D, Fokkens WJ, Bachert C, Newson RB, Bislimovska J et al. Chronic rhinosinusitis in European underestimated disease. A GA(2)LEN study. Allergy, 2011, 66: 1216-1223. doi:10.1111/j.1398-9995.2011.02646.x.Ragab SM, Lund VJ, Scadding G. Evaluation of the medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial. The Laryngoscope, 2004, 114 (5): 923-930. doi:10.1097/00005537-200405000-00027.Ragab SM, Lund VJ, Scadding G. Evaluation of the medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial. The Laryngoscope, 2004, 114 (5): 923-930. doi:10.1097/00005537-200405000-00027.Meltzer EO, Hamilos DL, Hadley JA, Lanza DC, Marple BF et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol, 2004, 114: 155-212. doi 10.1016/j.jaci.2004.09.029.Meltzer EO, Hamilos DL, Hadley JA, Lanza DC, Marple BF et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol, 2004, 114: 155-212. doi 10.1016/j.jaci.2004.09.029.Benninger MS, Ferguson BJ, Hadley JA, Hamilos DL, Jacobs M, Kennedy DW, Lanza DC, Marple BF, Osguthorpe JD, Stankiewicz JA, Anon J, Denneny J, Emanuel I, Levine H. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg, 2003, 129(3): 1-32.Benninger MS, Ferguson BJ, Hadley JA, Hamilos DL, Jacobs M, Kennedy DW, Lanza DC, Marple BF, Osguthorpe JD, Stankiewicz JA, Anon J, Denneny J, Emanuel I, Levine H. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg, 2003, 129(3): 1-32.Head K, Chong LY, Piromchai P, Hopkins C, Philpott C, Schilder AGM, Burton MJ. Systemic and topical antibiotics for chronic rhinosinusitis. Cochrane Database of Systematic Reviews, 2016, 4: CD011994. doi: 10.1002/14651858. CD011994.pub2. www.cochranelibrary.com.Head K, Chong LY, Piromchai P, Hopkins C, Philpott C, Schilder AGM, Burton MJ. Systemic and topical antibiotics for chronic rhinosinusitis. Cochrane Database of Systematic Reviews, 2016, 4: CD011994. doi: 10.1002/14651858. CD011994.pub2. www.cochranelibrary.com.Chong LY, Head K, Hopkins C, Philpott C, Schilder AGM, Burton MJ. Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis. Cochrane Database of Systematic Reviews, 2016, 4: CD011996. doi: 10.1002/14651858.CD011996. pub2. www.cochranelibrary.com.Chong LY, Head K, Hopkins C, Philpott C, Schilder AGM, Burton MJ. Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis. Cochrane Database of Systematic Reviews, 2016, 4: CD011996. doi: 10.1002/14651858.CD011996. pub2. www.cochranelibrary.com.Chong LY, Head K, Hopkins C, Philpott C, Burton MJ, Schilder AGM. Different types of intranasal steroids for chronic rhinosinusitis. Cochrane Database of Systematic Reviews, 2016, 4: CD011993. doi: 10.1002/14651858.CD011993. pub2. www.cochranelibrary.com.Chong LY, Head K, Hopkins C, Philpott C, Burton MJ, Schilder AGM. Different types of intranasal steroids for chronic rhinosinusitis. Cochrane Database of Systematic Reviews, 2016, 4: CD011993. doi: 10.1002/14651858.CD011993. pub2. www.cochranelibrary.com.Parnes SM, Chuma AV. Acute effects of antileukotrienes on sinonasal polyposis and sinusitis. J ENT, 2000, 79 (1):18-20.Parnes SM, Chuma AV. Acute effects of antileukotrienes on sinonasal polyposis and sinusitis. J ENT, 2000, 79 (1):18-20.Stewart RA, Ram B, Hamilton G, Weiner J, Kane KJ. Montelukast as an adjunct to oral and inhaled steroid therapy in chronic nasal polyposis. Otolaryngol Head Neck Surg, 2008, 139(5): 682-687. doi 10.1016/j.otohns.2008.07.010.Stewart RA, Ram B, Hamilton G, Weiner J, Kane KJ. Montelukast as an adjunct to oral and inhaled steroid therapy in chronic nasal polyposis. Otolaryngol Head Neck Surg, 2008, 139(5): 682-687. doi 10.1016/j.otohns.2008.07.010.Gevaert P, Calus L, Van Zele T, Blomme K, De Ruyck N, Bauters W, Hellings P, Brusselle G, De Bacquer D, Van Cauwenberge P, Bachert C. Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma. J Allergy Clin Immunol, 2013, 131: 110-116. doi: 10.1016/j.jaci.2012.07.047.Gevaert P, Calus L, Van Zele T, Blomme K, De Ruyck N, Bauters W, Hellings P, Brusselle G, De Bacquer D, Van Cauwenberge P, Bachert C. Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma. J Allergy Clin Immunol, 2013, 131: 110-116. doi: 10.1016/j.jaci.2012.07.047.Gevaert P, Lang-Loidolt D, Lackner A, Stammberger H, Staudinger H, Van Zele T, Holtappels G, Tavernier J, Van Cauwenberge P, Bachert C. Nasal IL-5 levels determine the response to anti-IL-5 treatment in patients with nasal polyps. J Allergy Clin Immunol, 2006, 118(5): 1133-1141. doi:10.1016/j.jaci.2006.05.031.Gevaert P, Lang-Loidolt D, Lackner A, Stammberger H, Staudinger H, Van Zele T, Holtappels G, Tavernier J, Van Cauwenberge P, Bachert C. Nasal IL-5 levels determine the response to anti-IL-5 treatment in patients with nasal polyps. J Allergy Clin Immunol, 2006, 118(5): 1133-1141. doi:10.1016/j.jaci.2006.05.031.Gevaert P, Van Bruaene N, Cattaert T, Van Steen K, Van Zele T, Acke F, De Ruyck N, Blomme K, Sousa AR, Marshall RP, Bachert C. Mepolizumab, a humanized anti-IL-5 mAb, as a treatment option for severe nasal polyposis. J Allergy Clin Immunol, 2011, 128(5): 989-995. doi: 10.1016/j.jaci.2011.07.056.Gevaert P, Van Bruaene N, Cattaert T, Van Steen K, Van Zele T, Acke F, De Ruyck N, Blomme K, Sousa AR, Marshall RP, Bachert C. Mepolizumab, a humanized anti-IL-5 mAb, as a treatment option for severe nasal polyposis. J Allergy Clin Immunol, 2011, 128(5): 989-995. doi: 10.1016/j.jaci.2011.07.056.Bachert C, Mannent L, Naclerio RM, Mullol J, Ferguson BJ, Gevaert P et al. Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial. JAMA, 2016, 315 (5): 469-479. doi: 10.1001/jama.2015.19330.Bachert C, Mannent L, Naclerio RM, Mullol J, Ferguson BJ, Gevaert P et al. Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial. JAMA, 2016, 315 (5): 469-479. doi: 10.1001/jama.2015.19330.

The authors declare that there are no conflicts of interest present.