S. Bakshi
Jan 4, 2016
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Influential Citations
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Journal
European Archives of Oto-Rhino-Laryngology
Abstract
I am writing to you in reference to a very interesting and thought provoking study published in your esteemed journal titled ‘Effect of topical ofloxacin on bacterial biofilms in refractory post-sinus surgery rhino-sinusitis’ by Ezzat et al. [1]. The article has been well written and sheds light on a very important aspect in management of patients with chronic rhinosinusitis. However, there are some aspects regarding the conclusion with which I disagree and would like to highlight the same through your esteemed journal. Biofilms play an important role in the pathogenesis of chronic rhinosinusitis and this has been proven in many previous studies [2]. Biofilms are robust structures and are very difficult to eradicate. The eradication of biofilms needs antibiotics in higher concentration doses than the regular microorganisms [3, 4]. In this regard, topical application antibiotics do seem to be a logical and effective way of delivering the same. Topical application can be in many forms like drops, nebulized antibiotics, or antibiotic rinses. The authors in the present study have chosen topical ofloxacin drops. However, I would like to ask the authors as to how long do these topical drops actually stay in the nose for them to act against these biofilms? Why only ofloxacin was chosen and not other antibiotics like mupirocin? How were the doses, duration, and frequency of application of the drops calculated? Another point of concern is the systemic toxicity of topical ofloxacin and other antibiotic nasal drops, which is still a topic of research. One more point I would like to make is many times it is possible that even after high concentrations of antibiotics is reached, the micro organisms in the core of the biofilms can escape [5] and can give rise to persistence of the sinusitis and acute exacerbations. In such a situation, using topical antibiotics can promote the development of antibiotic resistant strains which can be detrimental for the patients. All these factors must be kept in mind and more extensive scientific studies need to be conducted before a definite conclusion can be derived. In the end, I would like to quote a few previous similar studies in literature, which have proven that the role of topical antibiotics in chronic rhinosinusitis is limited and needs more evidence [6–9].