Are Antibiotics Sufficient for Treating Bacterial Rhinosinusitis? The Influence of Alpha-Lipoic Acid, a Potent Antioxidant, As an Additional Treatment in Bacterial Rhinosinusitis

Objective: Alpha-lipoic acid is an antioxidant agent with potential anti-inflammatory properties and is produced from octanoic acid. The aim of this study was to investigate the effects of alpha-lipoic acid on inflammation, oxidative status, tissue integrity in an animal model of experimen- tally induced acute rhinosinusitis and to compare these effects with the standard treatment, cefalosporin. Methods: Totally 30 healthy Wistar Albino rats were used in the experiment. The animals were randomly divided into 6 groups. An experimental sinusitis model was created Staphylococcus Aureus (SA) in the groups except for the healthy group. Over a 10-day period, groups were treated daily either with 50 mg/kg cefazolin (SA+cefazolin), alpha-lipoic acid 100 mg/kg (SA+alpha-lipoic acid 100), alpha-lipoic acid 200 mg/kg (SA+alpha-lipoic acid 200), or alpha-lipoic acid 200 mg/kg+cefazolin 50 mg/kg (SA+alpha-lipoic acid 200+cefazolin). At the end of the test, the animals were euthanized, and the maxillary sinus mucosa was removed. Mucosa samples were examined for superoxide dismutase activity and glutathione, malondialdehyde, tumor necrosis factor-alpha mRNA, and interleukin-1β mRNA levels. Results: Histopathological examination showed lesser changes in SA + cefazolin group compared to the control group and inflammation pro- portionally with alpha-lipoic acid dose in rhinosinusitis-induced groups treated with alpha-lipoic acid. Increased levels of malondialdehyde, tumor necrosis factor-alpha mRNA, and interleukin-1β mRNA in rhinosinusitis-induced groups approached the healthy group in SA+alpha- lipoic acid 200 + cefazolin group. Decreased superoxide dismutase activity and glutathione level in induced rhinosinusitis groups were close to that of healthy group in SA + alpha-lipoic acid 200 + cefazolin group. Conclusion: The results of the study revealed that using a potent antioxidant and/or anti-inflammatory agent along with an antibacterial agent could be more effective in reducing oxidative stress and cytokine levels in the treatment of bacterial infections like sinusitis. Cite this article as: Efe Atila N, Kaya Z, Atila A, et al. Are antibiotics sufficient for treating bacterial rhinosinusitis? The influence of alphalipoic acid, a potent antioxidant, as an additional treatment in bacterial rhinosinusitis. B-ENT. 2022;18(4):216-224.