Evaluation of Drug Utilization Patterns of Topical Intranasal Corticosteroid Therapy in Chronic Rhinosinusitis

Background and Objective: Chronic rhinosinusitis (CRS) is a highly prevalent inflammatory condition of the paranasal sinuses, significantly impacting patients' quality of life. Topical intranasal corticosteroids (INCS) represent the cornerstone of medical management for both CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). However, prescribing patterns vary widely among otolaryngologists and general practitioners. This study aims to evaluate the drug utilization patterns, adherence to the World Health Organization (WHO) core prescribing indicators, and the tolerability profile of INCS therapy in patients diagnosed with CRS in a tertiary care setting.

Methods: A prospective, observational study was conducted in the Otorhinolaryngology (ENT) outpatient department of a tertiary care hospital over a period of 6 months. Adult patients (≥18 years) diagnosed with CRS and prescribed INCS were enrolled after obtaining informed consent. Data regarding patient demographics, clinical history, diagnostic category, prescribed INCS (type, dose, frequency, generic/brand name), concomitant medications, and adverse drug reactions (ADRs) were recorded using a specially designed Case Record Form (CRF). Data were analyzed using descriptive statistics.

Results: A total of 320 patients were enrolled, with a mean age of 42.5 ± 14.2 years and a male predominance (58.1%). CRSsNP was the most common diagnosis (65.6%). The most frequently prescribed INCS was Fluticasone propionate (41.2%), followed by Mometasone furoate (32.5%) and Budesonide (15.0%). Assessment of WHO core prescribing indicators revealed that the average number of drugs per encounter was 3.2. Only 28.4% of INCS were prescribed by their generic names. The percentage of encounters with an antibiotic prescribed was 22.5%. Concomitant prescriptions heavily featured isotonic saline irrigation (78.1%) and oral antihistamines (45.3%). Mild, self-limiting ADRs—predominantly epistaxis (8.4%) and nasal dryness (11.2%) were reported, with a higher incidence noted in patients utilizing first-generation INCS (Beclomethasone).

Conclusion: The utilization pattern of INCS in this tertiary care setting aligns largely with international treatment guidelines, favoring newer generation INCS with low systemic bioavailability (Fluticasone and Mometasone). However, there is a significant deviation from WHO recommendations regarding generic prescribing, highlighting a need for continuing medical education on rational prescribing practices to reduce the economic burden on patients