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Abstract
Rhinoscleroma is a chronic inflammatory disease which is difficult to cure. Long term antibiotic course is the cornerstone of treatment, many chemotherapeutic agents were used to this end.
We did this study to evaluate the efficacy and outcome of different antibiotics and which one among these antibiotics is proved to be the most active as regard rhinoscleroma after long term course of use?
Most of the studies found are weak studies, only 2 articles out of 104 articles which were included, both studies compared different antibiotics for treatment of rhinoscleroma.
We analyzed the two articles selected according to the previously selected inclusion criteria and its analysis using Meta analytic software (RevMan 5).
The first one (Borgstein et al. ,1993) is a prospective comparative clinical trial which ensure the superiority of Ciprofloxacin over the widely used Rifampicin combined with Co-trimoxazole with significant difference as regard the bacteriological outcome.
The second study is small randomized trial (Ssali. , 1975) was done for this end but the study compared 7 different antibiotics which are considered large number in relation to the total number of participants (85 patients) and it was better to compare only 2 important antibiotics with significant results. The analysis of this study ensure that Ampicillin and tetracycline had statistically significant better bacteriologic outcome than the rest of the antimicrobials used in the study. Erythromycin and chloramphenicol showed statistically significant worse bacteriologic outcome than the rest of antimicrobials used, while septrin, streptomycin and vibramycin had equivocal results.
We also discuss the other non randomized and non comparative studies to form an idea about the results of other antimicrobials used in this disease.
Data available ensure the need for more randomized control trials to determine more accurately the best antibiotic agent of treatment for rhinoscleroma.
Ciprofloxacin has been proven to be more active in the treatment of this disease even when it is compared with the widely used rifampicin combined with co-trimoxazole, also it is considered safe compared to the other antibiotics used and it can be used for shorter course to achieve cure for this end. But also there are many other antibiotics that show good activity for this end, namely rifampicin whether local or systemic, tetracyclin, co-trimoxazole, streptomycin, ampicillin,third generation cephalosporins (cefotaxime), local acriflavin and other less active antibiotics as erythromycin, chloramphenicol and others. Also clofazemin was used with promising results.