Hypertonic and isotonic saline solutions in irrigation therapy for acute rhinosinusitis: clinical benefits and contribution to the antibiotic stewardship program. Literature review.

Irrigation therapy with saline solutions is an important component of the treatment of acute inflammatory diseases of nose and paranasal sinuses. The aim of this review was to compare the clinical efficacy and tolerability of hypertonic and isotonic seawater solutions, as well as to evaluate their early effect on the main symptoms of acute rhinosinusitis, which is important in the tactics of delayed antibiotic prescription. Evaluation of available clinical trials has shown that hypertonic saline provides a faster reduction in symptoms in the first days of treatment due to an osmotic decongestant effect and improvement in clinical symptoms. This early clinical improvement is associated with a reduction in the frequency of antibiotic prescriptions, which is important in the context of antibiotic stewardship programs and the fight against antimicrobial resistance. At the same time, at the final stage of treatment (after 7-8 days), the difference between hypertonic and isotonic saline solutions is leveled: both agents demonstrate comparable efficacy in terms of the criteria of clinical recovery. The tolerability of both types of solutions is good and comparable, since no significant adverse effects were registered, and short-term discomfort when using hypertonic saline did not affect adherence to treatment. The data obtained confirm the feasibility of using hypertonic saline at the early stages of therapy and the equivalence of both solutions in the long term, which emphasizes their role as an effective tool of antibiotic stewardship.