Infection of sinuses by fungi, or fungal sinusitis, can occur in several forms. Otherwise healthy people can have simple overgrowths of fungus, characterized by sinus pain, pressure and nasal congestion. Other people experience an allergic, inflammatory reaction, characterized by marked nasal congestion. Finally, invasive fungal sinusitis is a serious condition that commonly occurs in immunocompromised individuals. Antifungals are the drugs of choice to treat fungal sinusitis.
Amphotericin B is an antifungal medication that binds to the fungal cell membrane, thereby causing membrane leakage and cell death. Amphotericin B is commonly administered intravenously to treat severe invasive fungal sinusitis in individuals with reduced immunity. An article published in the April 2001 edition of the "Journal of Medical Association of Thailand" states that treatment with amphotericin B effectively supplements surgery, which is the mainstay of treatment especially in immunocompromised individuals.
Common side effects include fever, chills, fast breathing and headache. MedlinePlus warns that amphotericin B can cause serious side effects and hence should be used only for the treatment of potentially fatal fungal infections.
Voriconazole belongs to a class of antifungals known as triazoles and is used to treat fungal sinusitis caused by Aspergilla and Candida species. Voriconazole works by slowing the growth of the fungi and can be given orally or intravenously depending on the condition of the patient. Side effects of voriconazole are mild compared to amphotericin B and include diarrhea, vomiting, dizziness and vision changes. In fact, according to case study published in the January 2008 edition of "Ear Nose Throat Journal," a patient with severe Aspergillus sinisitis who was unwilling to undergo surgery and whose condition was too weak for amphotericin B treatment was effectively treated using voriconazole in combination with another antifungal drug known as caspofungin.
Itraconazole also belongs to class of triazoles and has a mechanism of action similar to that of voriconazole. It is commonly used to treat fungal infections of the respiratory tract and is generally available in tablet or suspension form. The medicine should be taken on a full stomach for about 2 to 8 weeks, as prescribed by a physician. According to a May-June 2009 article in the "American Journal of Rhinology and Allergy," oral itraconazole may help fungal sinusitis patients with failed therapy and surgery and may prevent frequent recurrences.
Common side effects of itraconazole include upset stomach, headache, dizziness and muscle pain. Itraconazole can cause congestive heart failure, and therefore it is important to inform the doctor of any history of heart disease.
- ScienceDaily.com: Mayo Clinic Study Implicates Fungus As Cause Of Chronic Sinusitis
- "Journal of Medical Association of Thailand"; Treatment of Invasive Fungal Sinusitis With Liposomal Amphotericin B: A Report of Four Cases; S. Sungkanuparph et al.; April 2001
- MedlinePlus: Amphotericin B Injection
- "Ear Nose Throat Journal"; Successful Treatment of Invasive Aspergillus Sinusitis With Caspofungin and Voriconazole.; L. Chirch, P. Roche, and J. Fuhrer; January 2008
- "American Journal of Rhinology and Allergy"; The Use of Itraconazole in Recalcitrant Fungal Sinusitis; Kristin Seiberling and Peter J. Wolmard; May-June 2009