EFFICACY OF POST-OPERATIVE VORICONAZOLE IN MANAGEMENT OF CHRONIC INVASIVE FUNGAL RHINOSINUSITIS

Abstract

Background and Objective: Chronic invasive fungal rhinosinusitis (CIFRS) is a gradually progressive disease requiring surgical debridement followed by systemic antifungal therapy. There is limited evidence regarding the use of standardized postoperative voriconazole treatment. The primary objective is to assess short-term clinical, endoscopic, radiological and safety outcomes of voriconazole after functional endoscopic sinus surgery (FESS).

Methods: This prospective single-arm interventional case series included 60 patients. Following surgical debridement, participants received oral voriconazole 400 mg every 12 hours for the first 24 hours and 200 mg every 12 hours for two months. Outcomes were assessed over 12 weeks through symptom evaluation, nasal endoscopy, Lund–Mackay scoring, and laboratory monitoring.

Results: Disease control was observed in 48/60 patients (80.0%; 95% CI: 68.2%–88.2%). Resolution occurred in 52/60 patients with nasal obstruction, 42/48 with facial pain, 40/45 with headache, and 43/50 with rhinorrhea. At 12 weeks, 44/60 patients had no visible polyposis. Mean Lund–Mackay score decreased from 16.5 ± 3.2 to 5.8 ± 2.6. Visual disturbance, elevated liver enzymes, and skin reactions occurred in 8.3%, 6.7%, and 5.0%, respectively.

 Conclusion: Combined surgery and postoperative voriconazole were associated with favourable short-term outcomes and predominantly mild adverse effects, although voriconazole-specific efficacy could not be established without a comparator.