Nasal Mupirocin fails to Prevent Symptom Recurrence After Sinus Surgery for Nasal Polyps: Study

Chronic rhinosinusitis with nasal polyps is a prevalent condition that can lead to significant discomfort and impact quality of life. The surgical procedure aims to alleviate symptoms, but recurrence remains a challenge for many patients. Staphylococcus aureus has been recognized as a pathogen associated with the recurrence of symptoms in patients suffering from chronic rhinosinusitis with nasal polyps.

Against the above background, Alireza Mohebbi, NT and Head & Neck Research Center, Hazrat Rasoul Hospital/ The Five Health Senses Institute, Iran University of Medical Sciences, Tehran, Iran, and colleagues examined the effectiveness of mupirocin ointment applied to the nasal vestibule in reducing symptom recurrence and enhancing the outcomes of functional endoscopic sinus surgery.

For this purpose, the researchers included patients with chronic rhinosinusitis, nasal polyps, and a positive culture for Staphylococcus aureus in a clinical trial. The right nostril was designated as the intervention group, receiving mupirocin ointment, while the left nostril served as the control group, receiving vitamin A ointment. Lund-Mackay radiological scores and Lund-Kennedy endoscopic scores were assessed at diagnosis and again six months later.

The following were the key findings of the study:

• Among 60 patients with chronic rhinosinusitis with nasal polyps, 91.6% were positive for nostril Staphylococcus aureus.
• Comparing the average of the diagnostic radiological and endoscopic scores with the follow-up values in both groups indicated a significant improvement after surgery.
• There was no significant difference in the radiological and endoscopic score improvements between the study and control groups.

The findings revealed that administering mupirocin ointment twice daily in the nostrils of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) does not significantly impact surgical outcomes following endoscopic nasal surgery. The researchers suggest that the use of mupirocin in these patients should be approached cautiously due to the potential for promoting the growth of gram-negative pathogenic bacteria.

The authors recommend conducting further studies with larger sample sizes to compare mupirocin with other topical antibiotics in preventing relapse in CRSwNP patients. Additionally, they propose evaluating the effects of combining mupirocin with other effective antibiotics targeting gram-negative bacteria.

"Future research should also explore different administration methods and dosages of mupirocin, comparing short-term, medium-term, and long-term results," they concluded.

Reference:

Mohebbi AR, Mohsenian M, Elahi M, Minaeian S. Mupirocin Ointment Effect on Polyposis. Recurrence After Sinus Surgery. Iran J Otorhinolaryngol. 2024:36(5):573-580. Doi: 10.22038/ijorl.2024.70685.3405