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The Effectiveness of Nasal Nebulizer Therapy with Cefmenoxime Hydrochloride and Nasal Drops of Povidone Iodine for Acute Rhinosinusitis in Children

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The Effectiveness of Nasal Nebulizer Therapy with Cefmenoxime Hydrochloride and Nasal Drops of Povidone Iodine for Acute Rhinosinusitis in Children

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Abstract

We clinically studied the effectiveness of nasal nebulizer therapy with cefmenoxime hydrochloride (CMX) and nasal drops of povidone iodine for acute rhinosinusitis in children. We evaluated the results using the standard for new antibiotics of the Japanese Society of Chemotherapy. The subjects were 50 children with acute rhinosinusitis. By the standard for total evaluation, consisting of clinical and bacteriological study, the cure rate of the CMX nebulizer group was 68%, that of the group using nasal drops of povidone iodine was 23.1%, and that of the controls was 38.5%. The cure rate with nasal drops of povidone iodine was not higher than that with CMX nebulizer therapy. However, with the nasal drops of povidone iodine, in 2 of 3 cases, PISP (penicillin intermediately resistant S. pneumoniae) disappeared and in 2 of 2 cases, MRSA (methicillin-resistant S. aureus) disappeared. The nasal drops of povidone iodine were found to be effective for drug-resistant organisms such as PISP and MRSA.

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... However, the frequency and the duration of the nebulized therapy depending on the patients need to be confirmed. For patients who have no effect after a 2-week nebulizer therapy, the option is to change the drug solutions based on the species of causative pathogen bacteria and their antimicrobial susceptibilities [20][21][22]. The nebulizer therapy with corticosteroids (Betamethasone 0.33 mg/1 mL) three times in a week has a significantly higher efficacy than treatment with an oral medication of antiinflammatory enzyme drug alone [23] (Table2). ...
Article
The guidance deals with the recommended applications, procedures, and safety management of nebulizer therapy for acute rhinosinusitis. In Japan, nebulizer therapy for sinusitis has been covered by public health insurance since 1958 and has been commonly carried out nationwide. The Japan Society for Infection and Aerosol in Otorhinolaryngology and the Oto-Rhino-Laryngological Society of Japan set up a working group to draw up a consensus guidance on nebulizer therapy for acute rhinosinusitis. The device for nebulizer therapy are classified into jet, ultrasound, and mesh types. In Japan, cefmenoxime hydrochloride (CMX) was approved for use in nebulizer therapy since 1996. The widening of the obstructed lesions such as large polyps prior to nebulizer therapy were recommended. The numbers of times of nebulizer therapy is recommended for three times in a week for at least for 2 weeks (cure rate: 68%, eradication ratio: 48%). Concerns should be pay for the changes of activity of medicine due to the mixing and bacterial contamination. Pseudomonas cepacia growing in a short even in both saline and distilled water leads to contamination at high concentrations by 2 days. Nebulizer therapy is an effective treatment based on a drug delivery system (DDS) to the nasal and paranasal cavities. The therapy effectively increases the local drug concentration by promptly and uniformly delivering drugs to a targeted local site. The therapy is safe with less systemic absorption and with few adverse reactions.
Article
Background: The efficacy of decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated. Methods: Selection criteria: Randomized controlled trials (RCTs) and quasi-RCTs that evaluated children <18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough, were included. Trials involving children with chronic sinusitis and allergic rhinitis were excluded. Data analysis: Two review authors independently assessed each study for inclusion. Results: Of the 662 studies identified through the electronic and manual searches, none met all of the inclusion criteria. Conclusions: There is no evidence to determine whether the use of antihistamines, decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.
Article
The efficacy of decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated. To systematically review the efficacy of decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis. We considered the following four interventions: 1) decongestants versus placebo or no medication, 2) antihistamines versus placebo or no medication, 3) decongestant and antihistamine combination versus placebo or no medication, 4) nasal irrigation versus no irrigation. The primary outcomes of the review were symptom resolution (improvement in symptom score from enrolment to day 5) and overall symptom burden (as measured by average symptom scores while on therapy). We searched the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2010), which includes the Acute Respiratory Infections Group's Specialized Register, MEDLINE (1950 to May Week 1, 2010) and EMBASE (1950 to January 2010). We included randomized controlled trials (RCTs) and quasi-RCTs which evaluated children less than 18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic sinusitis and allergic rhinitis. Two review authors independently assessed each study for inclusion. Of the 402 studies found through the electronic searches and handsearching, none met all the inclusion criteria. There is no evidence to determine whether the use of antihistamines, decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.
Article
OBJECTIVE: To study the nasopharyngeal colonization in otitis-prone children before and after adenoidectomy. METHODS: The study population consisted of 35 children between 11 months and 4 years of age, undergoing adenoidectomy and tube placement for recurrent acute otitis media. All these children were otitis prone (OP). During general anesthesia, bacteriologic samples were obtained from the nasopharynx and the middle ear fluid, if present. During the follow-up visit, a new nasopharyngeal culture was taken. The control population consisted of 35 children undergoing surgery for non-ear-nose-throat pathology. These children had no history of recurrent upper respiratory tract infections. RESULTS: Colonization of the nasopharynx with potential pathogens (Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae) occurred significantly more in the OP children than in the non-OP children. Adenoidectomy resulted in a substantial decrease of potential middle ear pathogens in the nasopharynx and an increase of normal commensal flora. In about half of the patients, middle ear fluid was still present at the time of tube placement; in most instances, H. influenzae was cultured. Typing with arbitrarily primed PCR indicated substantial genetic diversity among the H. influenzae isolates studied. CONCLUSIONS: Both cross-colonization (between sampling sites within the same patient and between siblings) and turnover appeared to be high.