In December 2002, a study was published in the Journal of Allergy and Clinical Immunology, the results of which indicate that the intranasal use of amphotericin B improves in many cases the course of rhinosinusitis chronic (CRS).

Earlier, the research team of Dr. J. Ponikau (Minnesota, USA) revealed that pathogenic fungi are often found in the contents of the sinuses in patients with chronic renal failure. However, it turned out that in the majority of healthy individuals examined by them, the mucous membrane of the sinuses is also colonized by pathogenic fungi.

Researchers hypothesized that the difference between CDS patients and healthy individuals is not the presence of pathogenic fungi in the sinuses as such, but the nature of the immune system's response to them.. In this regard, it has been suggested that pathogenic fungi could activate the sensitized immune system in patients with chronic renal failure, thereby leading to the development of eosinophilic inflammation in the nasal mucosa and paranasal sinuses.

To confirm his hypothesis, Dr. Ponikau et al. conducted a study, which included 51 patients with HRS. Amphotericin B was administered intranasally to all patients twice a day as a solution, 1 ml of which contains 100 μg of drug (the daily dose was 20 ml).

The authors point out that 38 patients showed a decrease in the severity of the symptoms of rhinosinusitis. In addition, an endoscopic examination revealed that 18 patients had completely disappeared from the inflammatory changes, and the remaining 20 patients showed a significant improvement in objective indicators of the course of the disease (p less than 0.001). In 13 patients, amphotericin B had no apparent benefit.

Thirteen patients included in the study, before the start of treatment and after its completion, a study of the maxillary sinuses was carried out by CT. Analysis of the examination results showed that treatment with amphotericin B helps to reduce an indicator such as the thickness of the mucosa of the inflamed sinuses (p less than 0.0001).

According to the researchers, this open pilot study suggests that intranasal use of antifungal drugs is a safe and effective treatment for most patients with chronic kidney disease.

In view of the results obtained, Dr. Poniaku believes that to finally determine the efficacy and the optimal therapeutic regimen, as well as to prove the role of pathogenic fungi in the etiology and pathogenesis of chronic rhinosinusitis, double-blind studies, placebo-controlled, in which the dynamics of various indicators of the inflammatory process.