Management of chronic rhinosinusitis: the therapeutic potential of bacteriophages in the era of antibiotic resistance

Management of chronic rhinosinusitis: the therapeutic potential of bacteriophages in the era of antibiotic resistance

N.S. Kozlova^1,2, I.M. Kirichenko^1,2, V.I. Popadyuk¹, A.I. Chernolev¹, T.A. Kochetova^3, G.T. Sadikova³, V.V. Yuskevich³, M.M. Gurkova³, N.I. Khromykh⁴, A.V. Gospodarik⁴, J.A. Bespyatykh⁴

Irina M. Kirichenko, e-mail: loririna@yandex.ru

¹RUDN University, Moscow

²On Clinic Arbat LLC, Moscow

³MicroMir Research and Production Center LLC, Moscow

⁴Lopukhin Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow

Background: chronic rhinosinusitis without nasal polyps (CRSsNP) remains a significant global health challenge, with 30–40% of cases proving refractory to conventional treatment. The prevalence of biofilm-forming and persistent infectious strains, coupled with escalating antibiotic resistance, necessitates the development of alternative treatment tactics.

Aim: to evaluate the efficacy of bacteriophages in the management of CRSsNP.

Materials and Methods: this prospective study included 66 patients with acute exacerbations of CRSsNP (group 1; 39 female and 27 male patients, mean age 42.81±1.36 years,), including 25 patients with a history of endoscopic sinus surgery (from 1 to 15 years) and 41 as non-operated patients. The control group (group 2) comprised 30 patients with acute CRSsNP (17 female and 13 male patients, mean age 42.17±2.01 years). Both groups received standard therapy (elimination therapy, topical intranasal corticosteroids, and topical antibiotics). Group 1 additionally received a bacteriophage-based gel applied after elimination therapy intranasally 2 ml twice daily for 14 days. Assessments included microbiological identification, antibiotic/phage sensitivity testing, rhinocytogram analysis, and subjective symptom evaluation using a 10-mm VAS for pain, purulent discharge, headache, postnasal drip, and olfaction. Samples were taken before the start of therapy and at least 2 weeks after the completion of treatment.

Results: post-treatment microbiological analysis revealed positive trend in 45% (30/66) of patients in group 1 versus 20% (6/30) in group 2 (p=0.018). Rhinocytogram data in group 1 showed a significantly higher rate of inflammation reduction (decreased neutrophils, lymphocytes, and desquamated epithelium) at 49% (32 patients) versus 23% (7 patients) in group 2 (p=0.016). Group 1 also demonstrated superior improvement in subjective symptoms, particularly in olfaction, postnasal drip, and nasal obstruction. Total VAS scores in group 1 decreased from 5.40±2.55 to 2.03±1.61, while group 2 scores moved from 5.26±2.70 to 3.49±2.39 (p<0.01).

Conclusion: a gel-based bacteriophage complex serves as an effective adjunct to standard therapy for CRSsNP and represents a promising tool for managing refractory cases.

Keywords: chronic rhinosinusitis without polyps, bacteriophages, phage therapy, antibiotic resistance, biofilms.

For citation: Kozlova N.S., Kirichenko I.M., Popadyuk V.I., Chernolev A.I., Kochetova T.A., Sadikova G.T., Yuskevich V.V., Gurkova M.M., Khromykh N.I., Gospodarik A.V., Bespyatykh J.A. Management of chronic rhinosinusitis: the therapeutic potential of bacteriophages in the era of antibiotic resistance. RMJ. 2026;1:50–56. DOI: 10.32364/2225-2282-2026-1-10