Topical Colloidal Silver for the Treatment of Recalcitrant Chronic Rhinosinusitis

Mian L Ooi,Katharina Richter,Luis Macias-Valle,Alkis J Psaltis,Catherine Bennett,Sarah Vreugde,Peter-John Wormald

doi:10.3389/fmicb.2018.00720

Abstract

Background: The management of recalcitrant chronic rhinosinusitis (CRS) is challenged by difficult-to-treat polymicrobial biofilms and multidrug resistant bacteria. This has led to the search for broad-spectrum non-antibiotic antimicrobial therapies. Colloidal silver (CS) has significant antibiofilm activity in vitro and in vivo against S. aureus, MRSA, and P. aeruginosa. However, due to the lack of scientific efficacy, it is only currently used as an alternative medicine. This is the first study looking at the safety and efficacy of CS in recalcitrant CRS.Methods: Patients were included when they had previously undergone endoscopic sinus surgery and presented with signs and symptoms of sinus infection with positive bacterial cultures. Twenty-two patients completed the study. Patients were allocated to 10–14 days of culture directed oral antibiotics with twice daily saline rinses (n = 11) or 10 days of twice daily 0.015 mg/mL CS rinses (n = 11). Safety observations included pre- and post-treatment serum silver levels, University of Pennsylvania Smell Identification Test (UPSIT) and adverse event (AE) reporting. Efficacy was assessed comparing microbiology results, Lund Kennedy Scores (LKS) and symptom scores using Visual Analog Scale (VAS) and Sino-Nasal Outcome Test (SNOT-22).Results: CS demonstrated good safety profile with no major adverse events, no changes in UPSIT and transient serum silver level changes in 4 patients. CS patients had 1/11 (9.09%) negative cultures, compared to 2/11 (18.18%) in the control group upon completion of the study. Whilst not statistically significant, both groups showed similar improvement in symptoms and endoscopic scores.Conclusion: This study concludes that twice daily CS (0.015 mg/mL) sinonasal rinses for 10 days is safe but not superior to culture-directed oral antibiotics. Further studies including more patients and looking at longer treatment or improving the tonicity of the solution for better tolerability should be explored.

Highlights

The management of recalcitrant chronic rhinosinusitis (CRS) is increasingly challenged by difficult-to-treat polymicrobial biofilms and multidrug resistant bacteria which antibiotics often cannot effectively eradicate
We have previously shown that colloidal silver (CS) showed significant anti-biofilm activity in vitro and in vivo against S. aureus (Goggin et al, 2014; Rajiv et al, 2015), and against methicillin-resistant S. aureus (MRSA) and P. aeruginosa biofilms
All results were statistically analyzed at the completion of the study using 2-way analysis of variance (ANOVA) and student’s t-test, with a significance value set at p < 0.05

Summary

Introduction

The management of recalcitrant chronic rhinosinusitis (CRS) is increasingly challenged by difficult-to-treat polymicrobial biofilms and multidrug resistant bacteria which antibiotics often cannot effectively eradicate. Antibiotics often alleviate symptoms in acute exacerbations but fail to eradicate the biofilm nidus which periodically sheds planktonic organisms resulting in a relapsing and remitting course of disease (Foreman et al, 2011) This has fuelled a continuous search for broad-spectrum topical non-antibiotic anti-biofilm therapies. The management of recalcitrant chronic rhinosinusitis (CRS) is challenged by difficult-to-treat polymicrobial biofilms and multidrug resistant bacteria This has led to the search for broad-spectrum non-antibiotic antimicrobial therapies. This is the first study looking at the safety and efficacy of CS in recalcitrant CRS

Methods

Results

Discussion

Conclusion