Nonsurgical Treatment of Adenoidal Hypertrophy with Cefuroxime Axetil and Intranasal Mometasone Furoate Combination

Aim: Adenoidal hypertrophy causes substantial morbidity in childhood. This prospective randomized open-label trial was conducted in order to evaluate the efficacy of cefuroxime axetil (CEF) and mometasone furoate nasal spray (MFNS) combination treatment in symptomatic adenoidal hypertrophy, in comparison to either treatment alone, or controls (CON). Material and Methods: Three to 14 years old 128 children with symptomatic adenoidal hypertrophy were randomized to receive a 4 week-course of CEF (30 mg/kg in 2 divided doses daily, po), MFNS (100 mg once daily), CEF plus MFNS (in same doses), or normal saline as control (CON). After cessation of therapy, they were followed-up for 2 months. Main outcome measures were changes from baseline in total symptom score, and air column/soft palate (AC/SP) ratio on lateral neck radiograph on the 4th and 12th week control visits. Results: The improvement in mean symptom score of CEF plus MFNS group was significantly (p= 0.017) higher than CON group at the end of 4th week. Increase in mean AC/SP ratio from baseline to 12th week in CEF plus MFNS group was significantly greater than CON group and other two groups (p= 0.03). Neither CEF, nor MFNS alone was better than CON on any visit. The changes in symptom scores or radiographic measurements were not different between atopic and nonatopic patients. Conclusion: Oral CEF plus MFNS combination therapy of one month's duration may delay, or substitute, surgical intervention in some pediatric outpatients with mild to moderate adenoidal hypertrophy. (J Pediatr Inf 2007; 1: 6-12)