Effectiveness of systemic voriconazole in reducing post-surgical recurrence of aspergillus mycotic rhinosinusitis.

Abstract

Objective: To determine voriconazole efficacy in postoperative FESS patients to prevent or minimize recurrence of Aspergillus associated rhinosinusitis. Study Design: Observational Prospective Analytical. Setting: Department of ENT and Head & Neck Surgery, KRL Hospital Islamabad. Period: 01.07.2021 to 30.06.2022. Methods: 57 patients (selected by simple random sampling technique) who underwent FESS for mycotic disease caused by Aspergillus species were followed prospectively as per the department’s follow up protocols while receiving post-operative voriconazole. The initial dose and duration of oral drug advised depended on the severity and extent of disease at the time of surgery and the dose was adjusted on subsequent OPD reviews based on endoscopic nasal examination findings, visual analogue score for total nasal sinus symptoms as well as radiological findings where necessary. The success of treatment was monitored to check the efficacy of voriconazole in preventing post-surgical recurrence and the importance of response-based dose adjustments in patients suffering from mycotic rhinosinusitis. Data analysis was done using SPSS version 20. Results: Among 57 patients (mean age 32 years), systemic voriconazole after FESS showed high efficacy, with 89.5% remaining relapse-free at one year. Only six patients (10.5%) developed recurrence, mostly after tapering therapy, and three (5.3%) discontinued treatment due to adverse effects or noncompliance. Serial VAS, CT, and endoscopy scores demonstrated progressive improvement, with 35.1% achieving complete recovery by 12 weeks. Conclusion: We would like to conclude that voriconazole has proven highly effective in the treatment of sinonasal aspergillosis and has been proven to be the drug of choice to compliment thorough surgical clearance. Re-administration of voriconazole may be warranted at the slightest hint of recurrence noted on nasal endoscopic or radiological examination which may need to be biopsy proven.