Re: re; Irrigation with baby shampoo

[Guest guest]

Hello Wayne,N-acetylcysteine is fine for depolymerizing biofilm structures, but will not kill bacteria, you would have to add an antibiotic at the same time. In the following study, Mupirocin came out better than CAZS.2% citric acid is likely to irritate ; one would normally add some steroid to the solution to offset that, but you need to not be sensitive to topical steroid side effects.------------Am J Rhinol. 2008 Nov-Dec;22(6):560-7.The efficacy of topical antibiofilm agents in a sheep model of rhinosinusitis.Le T, Psaltis A, Tan LW, Wormald PJ.Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia.AbstractBACKGROUND: Biofilms have been shown to be resistant to conventional antibiotic treatment. This study uses a sheep biofilm model developed by our department to investigate several novel topical anti-biofilm treatments. METHODS: Staphylococcal biofilms were grown in 54 sheep frontal sinuses over 8 days: Each sinus was randomized to (1) no intervention, (2) single mupirocin flush, (3) regular 12-hourly mupirocin flushes for 5 days, (4) Citric Acid Zwitterionic Surfactant (CAZS) via hydrodebrider, (5) gallium nitrate, (6) CAZS with gallium nitrate, (7) CAZS with mupirocin, and (8) saline regular flushes. Sheep were sacrificed and the sinus mucosa harvested 1 or 8 days after treatment to assess treatment and any biofilm regrowth. Confocal scanning laser microscopy was used to confirm the presence or absence of biofilms, and the extent of biofilm reduction was quantitated using fluorescent in situ hybridization and colony forming unit counts. RESULTS: In the control sheep biofilm coverage averaged 31.7%. Saline and mupirocin b.d. washes for 5 days had 23% and 0.84% coverage, respectively, when harvested on day 8. A single mupirocin and gallium wash had 7.7% and 16.2% on day 1 and 5.88% and 16.0% on day 8. CAZS with hydrodebrider had 6.66% on day 1 but 21.95% on day 8 whereas CAZS with hydodebrider and gallium had 13.3% on day 8. CONCLUSION: This study shows that regular treatment with mupirocin produced the most marked reduction in biofilm surface area coverage (0.84% and 1.25%) with sustained effects over the 8-day follow-up period.>> Has anyone considered adding citric or acetic acid to a saline nasal wash containing 1% baby shampoo.I am considering acetic acid basically trying to mimic CAZS (Citric acid/zwitterionic surfactant) that Dr. Desrosiers has been studying."The citric acid sequesters the Ca ion of the P.Aeruginosa extracellular polymeric substance structure,therby allowing the surfactant to bring the polymer into solution." See The Role Of Bacterial Biofilms and the Pathophysiology of CRS,Kilty S.,Desrosiers M.,Current Allergy and Asthma reports,2008,8:227-223. Also 2% acetic acid solution has been shown to be antibacterial and antifungal.( used externally for ear infections).Not sure whether this high would even be necessary or tolerable in a nasal wash.I am thinking that trying this might help with the crusting and possible fungal involvement as well as helping with any p.aerginosa or staph aureus biofilms.>

[Guest guest]

Detergent is typically basic (low Ph), so adding acid would neutralize

the solution. The amount of baby shampoo recommended was very small. I

would guess that it would replace the baking soda in our regular

formula. If you want to be safe, find some litmus strips. If you are

the " fly by the seat of your pants " type, taste it and guess. If it

passes the taste test, it won't hurt much.

Pam

asfy wrote:

>

>

> Hello Wayne,

>

> N-acetylcysteine is fine for depolymerizing biofilm structures, but

> will not kill bacteria, you would have to add an antibiotic at the

> same time.

>

> In the following study, Mupirocin came out better than CAZS.

>

> 2% citric acid is likely to irritate ; one would normally add some

> steroid to the solution to offset that, but you need to not be

> sensitive to topical steroid side effects.

>

> ------------

>

> Am J Rhinol. 2008 Nov-Dec;22(6):560-7.

>

>

> The efficacy of topical antibiofilm agents in a sheep model of

> rhinosinusitis.

>

> Le T

> <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Le%20T%22%5BAuthor%5D>, Psaltis

> A

> <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Psaltis%20A%22%5BAuthor%5D>, Tan

> LW

> <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Tan%20LW%22%5BAuthor%5D>, Wormald

> PJ

> <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Wormald%20PJ%22%5BAuthor%5D>.

>

> Department of Surgery-Otolaryngology Head and Neck Surgery, University

> of Adelaide, Adelaide, Australia.

>

>

> Abstract

>

> BACKGROUND: Biofilms have been shown to be resistant to conventional

> antibiotic treatment. This study uses a sheep biofilm model developed

> by our department to investigate several novel topical anti-biofilm

> treatments. METHODS: Staphylococcal biofilms were grown in 54 sheep

> frontal sinuses over 8 days: Each sinus was randomized to (1) no

> intervention, (2) single mupirocin flush, (3) regular 12-hourly

> mupirocin flushes for 5 days, (4) Citric Acid Zwitterionic Surfactant

> (CAZS) via hydrodebrider, (5) gallium nitrate, (6) CAZS with gallium

> nitrate, (7) CAZS with mupirocin, and (8) saline regular flushes.

> Sheep were sacrificed and the sinus mucosa harvested 1 or 8 days after

> treatment to assess treatment and any biofilm regrowth. Confocal

> scanning laser microscopy was used to confirm the presence or absence

> of biofilms, and the extent of biofilm reduction was quantitated using

> fluorescent in situ hybridization and colony forming unit counts.

> RESULTS: In the control sheep biofilm coverage averaged 31.7%. Saline

> and mupirocin b.d. washes for 5 days had 23% and 0.84% coverage,

> respectively, when harvested on day 8. A single mupirocin and gallium

> wash had 7.7% and 16.2% on day 1 and 5.88% and 16.0% on day 8. CAZS

> with hydrodebrider had 6.66% on day 1 but 21.95% on day 8 whereas CAZS

> with hydodebrider and gallium had 13.3% on day 8. CONCLUSION: This

> study shows that regular treatment with mupirocin produced the most

> marked reduction in biofilm surface area coverage (0.84% and 1.25%)

> with sustained effects over the 8-day follow-up period.

>

>

>

> >

> > Has anyone considered adding citric or acetic acid to a saline nasal

> wash containing 1% baby shampoo.I am considering acetic acid basically

> trying to mimic CAZS (Citric acid/zwitterionic surfactant) that Dr.

> Desrosiers has been studying. " The citric acid sequesters the Ca ion of

> the P.Aeruginosa extracellular polymeric substance structure,therby

> allowing the surfactant to bring the polymer into solution. " See The

> Role Of Bacterial Biofilms and the Pathophysiology of CRS,Kilty

> S.,Desrosiers M.,Current Allergy and Asthma reports,2008,8:227-223.

> Also 2% acetic acid solution has been shown to be antibacterial and

> antifungal.( used externally for ear infections).Not sure whether this

> high would even be necessary or tolerable in a nasal wash.I am

> thinking that trying this might help with the crusting and possible

> fungal involvement as well as helping with any p.aerginosa or staph

> aureus biofilms.

> >

>

>

>

[Guest guest]

Hi Asfy,I'm not sure what concentration of citric acid or surfactant

(caprylyl sulfobetaine) that Dr .Desrosiers used.The 2% acetic acid is what is

used in an otic preparation to treat ear infections topically.I was reading

another article " Are biofilms the answer in the pathophysiology and treatment of

chronic rhinosinusitis " ,Kilty S.J,Desrosiers,M.Y,Immunol Allergy Clin North

Am,2009,Nov;29(4),645-56

, and they feel that therapy will combine bacterial effects with a means for

reducing biofilm mass.The Mupiricin is more efficaceous for treating biofilms

assuming the biofilms haven't developed a resistance .

> >

> > Has anyone considered adding citric or acetic acid to a saline nasal

> wash containing 1% baby shampoo.I am considering acetic acid basically

> trying to mimic CAZS (Citric acid/zwitterionic surfactant) that Dr.

> Desrosiers has been studying. " The citric acid sequesters the Ca ion of

> the P.Aeruginosa extracellular polymeric substance structure,therby

> allowing the surfactant to bring the polymer into solution. " See The

> Role Of Bacterial Biofilms and the Pathophysiology of CRS,Kilty

> S.,Desrosiers M.,Current Allergy and Asthma reports,2008,8:227-223. Also

> 2% acetic acid solution has been shown to be antibacterial and

> antifungal.( used externally for ear infections).Not sure whether this

> high would even be necessary or tolerable in a nasal wash.I am thinking

> that trying this might help with the crusting and possible fungal

> involvement as well as helping with any p.aerginosa or staph aureus

> biofilms.

> >

>

[Guest guest]

Asfy,Mupiricin has been shown to be more efficacious in reducing bacterial

biofilms but wouldn't the biofilms eventually become resistant to mupiricin?I'm

not sure what the concentration of citric acid or the surfactant(caprylyl

sulfobetaine ) that Dr. Desrosiers used.The 2% acetic acid is what is used in an

otic preparation for topical treatment of ear infection.

Combining a bactericidal with a means of reducing biofilm mass would be

ideal. " Are biofilms the answer in the Pathophysiology and treatment of chronic

rhinosinusitis " Kilty,SJ,Desrosiers,MY,Immunol Allergy Clin North

Am,2009,nov29(4);645-646.

> >

> > Has anyone considered adding citric or acetic acid to a saline nasal

> wash containing 1% baby shampoo.I am considering acetic acid basically

> trying to mimic CAZS (Citric acid/zwitterionic surfactant) that Dr.

> Desrosiers has been studying. " The citric acid sequesters the Ca ion of

> the P.Aeruginosa extracellular polymeric substance structure,therby

> allowing the surfactant to bring the polymer into solution. " See The

> Role Of Bacterial Biofilms and the Pathophysiology of CRS,Kilty

> S.,Desrosiers M.,Current Allergy and Asthma reports,2008,8:227-223. Also

> 2% acetic acid solution has been shown to be antibacterial and

> antifungal.( used externally for ear infections).Not sure whether this

> high would even be necessary or tolerable in a nasal wash.I am thinking

> that trying this might help with the crusting and possible fungal

> involvement as well as helping with any p.aerginosa or staph aureus

> biofilms.

> >

>

[Guest guest]

For prolonged use, Mupirocin will eventually induce resistance. CAZS works well, but much better (say, two orders of magnitude better) when hydro-powered. Some topical ear preparations are great for the ear, but burn a lot when used in the nose (I've tried one that burned even though it had a steroid added). As Pam said, measure the pH first, eventually taste it, and then only a first real test in the nose will tell if it's tolerable - keep saline handy to wash out just in case. You can measure the pH of each component separately first to see if adjustments are needed, but buffering the pH may negatively affect the efficacy of the solution. For moderate basic buffering, dilute in Evian water (pH=7,2) instead of saline. You can also start with 0,25% citric acid instead of 2% as a test and build up as tolerated, which is what I'd do.> > >> > > Has anyone considered adding citric or acetic acid to a saline nasal> > wash containing 1% baby shampoo.I am considering acetic acid basically> > trying to mimic CAZS (Citric acid/zwitterionic surfactant) that Dr.> > Desrosiers has been studying."The citric acid sequesters the Ca ion of> > the P.Aeruginosa extracellular polymeric substance structure,therby> > allowing the surfactant to bring the polymer into solution." See The> > Role Of Bacterial Biofilms and the Pathophysiology of CRS,Kilty> > S.,Desrosiers M.,Current Allergy and Asthma reports,2008,8:227-223. Also> > 2% acetic acid solution has been shown to be antibacterial and> > antifungal.( used externally for ear infections).Not sure whether this> > high would even be necessary or tolerable in a nasal wash.I am thinking> > that trying this might help with the crusting and possible fungal> > involvement as well as helping with any p.aerginosa or staph aureus> > biofilms.> > >> >>

[Guest guest]

Another idea would be to irrigate pure N-acetylcysteine (available in Mucomyst ampules) to depolymerize the biofilm matrix, and a half-hour later irrigate an antibiotic (Mupirocin, etc), as in :Pol J Microbiol. 2009;58(3):261-7.Effect of ciprofloxacin and N-acetylcysteine on bacterial adherence and biofilm formation on ureteral stent surfaces.El-Feky MA, El-Rehewy MS, Hassan MA, Abolella HA, Abd El-Baky RM, Gad GF.Microbiology Department, Faculty of Medicine, Assuit University, Assuit, Egypt.AbstractThe aim of this study was to evaluate the effect of ciprofloxacin (CIP), N-acetylcysteine (NAC) alone and in combination on biofilm production and pre-formed mature biofilms on ureteral stent surfaces. Two strains each of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Klebseilla pneumoniae, Pseudomonas aeruginosa and Proteus vulgaris, recently isolated from patients undergoing ureteral stent removal and shown to be capable of biofilm production, were used in this study. The inhibitory effects of ciprofloxacin, N-acetylcysteine and ciprofloxacin/N-acetylcysteine combination were determined by static adherence assay. Ciprofloxacin (MIC and 2 MIC) and N-acetylcysteine (2 and 4 mg/ml) inhibited biofilm production by > or = 60% in all tested microorganisms. Disruption of pre-formed biofilms of all tested microorganisms was found to be > or = 78% in the presence of ciprofloxacin (MIC and 2 MIC) and > or = 62% in the presence of N-acetylcysteine (2 and 4 mg/ml), compared to controls. Ciprofloxacin/N-acetylcysteine showed the highest inhibitory effect on biofilm production (94-100%) and the highest disruptive effect on the pre-formed biofilms (86-100%) in comparison to controls. N-acetylcysteine was found to increase the therapeutic efficacy of ciprofloxacin by degrading the extracellular polysaccharide matrix of biofilms. These data are statistically significant. The inhibitory effects of ciprofloxacin and N-acetylcysteine on biofilm production were also verified by scanning electron microscope (SEM). In conclusion, Ciprofloxacin/N-acetylcysteine combinations have the highest inhibitory effect on biofilm production and the highest ability to eradicate pre-formed mature biofilms.and :J Chemother. 2006 Oct;18(5):507-13.Efficacy of N-acetyl-cysteine in combination with thiamphenicol in sequential (intramuscular/aerosol) therapy of upper respiratory tract infections even when sustained by bacterial biofilms.Macchi A, Ardito F, Marchese A, Schito GC, Fadda G.Clinica di Otorinolaringoiatria, Azienda Ospedaliera Universitaria, Ospedale di Circolo e Fondazione Macchi, Varese and Institutes of Microbiology, Catholic University of Rome, Italy.AbstractA total of 102 patients with recurrent upper respiratory tract infections underwent microbiological exploration with appropriate sampling and direct biopsies of the infected sites. Therapy was then started and on day 1 each patient received two intramuscular injections of thiamphenicol glycinate acetylcysteinate (TGA). From day 2 to 10 sequential therapy with the same drug was continued employing TGA administered by aerosol. All putative etiologic agents recovered were susceptible to thiamphenicol and only 24 demonstrated the ability to produce in vitro biofilms. The organisms comprised 10 Staphylococcus aureus, 6 Streptococcus pyogenes, 4 Streptococcus pneumoniae and 3 Haemophilus influenzae. Of the 24 subjects in whom biofilms were demonstrated to be present in vivo by Scanning Electron Microscopy, clinical and bacteriological cure was obtained in 21 cases (87.5%) following sequential therapy with TGA. Failures were considered to be persistent signs and symptoms at day 15 after initiation of treatment and lack of eradication of 3 S. aureus strains, despite their in vitro susceptibility to thiamphenicol. Very few adverse events attributable to TGA were reported in this cohort of patients. In no case was discontinuation of treatment deemed necessary by the attending physician.Appl Environ Microbiol. 2003 Aug;69(8):4814-22.N-acetyl-L-cysteine affects growth, extracellular polysaccharide production, and bacterial biofilm formation on solid surfaces.Olofsson AC, Hermansson M, Elwing H.Department of Cell and Molecular Biology-Interface Biophysics, Göteborg University, 405 30 Göteborg, Sweden. anki.olofsson@...AbstractN-Acetyl-L-cysteine (NAC) is used in medical treatment of patients with chronic bronchitis. The positive effects of NAC treatment have primarily been attributed to the mucus-dissolving properties of NAC, as well as its ability to decrease biofilm formation, which reduces bacterial infections. Our results suggest that NAC also may be an interesting candidate for use as an agent to reduce and prevent biofilm formation on stainless steel surfaces in environments typical of paper mill plants. Using 10 different bacterial strains isolated from a paper mill, we found that the mode of action of NAC is chemical, as well as biological, in the case of bacterial adhesion to stainless steel surfaces. The initial adhesion of bacteria is dependent on the wettability of the substratum. NAC was shown to bind to stainless steel, increasing the wettability of the surface. Moreover, NAC decreased bacterial adhesion and even detached bacteria that were adhering to stainless steel surfaces. Growth of various bacteria, as monocultures or in a multispecies community, was inhibited at different concentrations of NAC. We also found that there was no detectable degradation of extracellular polysaccharides (EPS) by NAC, indicating that NAC reduced the production of EPS, in most bacteria tested, even at concentrations at which growth was not affected. Altogether, the presence of NAC changes the texture of the biofilm formed and makes NAC an interesting candidate for use as a general inhibitor of formation of bacterial biofilms on stainless steel surfaces.However, it does not work with all antibiotics :J Antimicrob Chemother. 2009 Aug;64(2):317-25. Epub 2009 May 22.Importance of DNase and alginate lyase for enhancing free and liposome encapsulated aminoglycoside activity against Pseudomonas aeruginosa.Alipour M, Suntres ZE, Omri A.The Novel Drug & Vaccine Delivery Systems Facility, Department of Chemistry and Biochemistry, tian University, Sudbury, Ontario, P3E 2C6, Canada.AbstractOBJECTIVES: This study evaluated the potential of DNase, alginate lyase (AlgL) and N-acetylcysteine (NAC) in enhancing the in vitro bactericidal activity of conventional (free) and vesicle-entrapped (liposomal) gentamicin, amikacin and tobramycin. METHODS: The MICs and biofilm eradication for two clinical isolates of Pseudomonas aeruginosa (a mucoid strain and a non-mucoid strain) were determined in the presence and absence of AlgL. The co-activity of aminoglycosides with DNase and/or AlgL against endogenous P. aeruginosa in cystic fibrosis (CF) sputum was also measured. The inhibitory effects of mucin in the presence and absence of the mucolytic agent NAC on aminoglycosidic activity were also examined. RESULTS: The MIC values of the liposomal aminoglycosides were similar to or lower than those of free aminoglycosides. Biofilm formation increased the bactericidal concentrations of these drugs by 8- to 256-fold and treatment with AlgL improved killing of the mucoid strain. The activity of some aminoglycosides against the sputum was increased by the addition of DNase or AlgL (P < 0.05), and was increasingly evident with concurrent DNase and AlgL administration. Addition of mucin inhibited liposomal aminoglycosidic activity (up to 32-fold) evidently more than the free aminoglycosides (up to 8-fold). The addition of NAC did not improve activity significantly (P > 0.05). Tobramycin was the most effective aminoglycoside to reduce biofilms and sputum. CONCLUSIONS: Liposomal aminoglycosides do not fare better than conventional forms. The co-administration of DNase and AlgL is essential for enhanced activity in reducing biofilm growth and sputum bacterial counts. While mucin retards bactericidal activity, NAC does not improve aminoglycosidic activity.> > >> > > Has anyone considered adding citric or acetic acid to a saline nasal> > wash containing 1% baby shampoo.I am considering acetic acid basically> > trying to mimic CAZS (Citric acid/zwitterionic surfactant) that Dr.> > Desrosiers has been studying."The citric acid sequesters the Ca ion of> > the P.Aeruginosa extracellular polymeric substance structure,therby> > allowing the surfactant to bring the polymer into solution." See The> > Role Of Bacterial Biofilms and the Pathophysiology of CRS,Kilty> > S.,Desrosiers M.,Current Allergy and Asthma reports,2008,8:227-223. Also> > 2% acetic acid solution has been shown to be antibacterial and> > antifungal.( used externally for ear infections).Not sure whether this> > high would even be necessary or tolerable in a nasal wash.I am thinking> > that trying this might help with the crusting and possible fungal> > involvement as well as helping with any p.aerginosa or staph aureus> > biofilms.> > >> >>

[Guest guest]

Thanks Asfy for your references with N-acetycysteine (mucomyst ampules),I will

try to get mucomyst and cromyln sodium (as in Intal capsules) fom my M.D.. I was

reading " Mast Cell Modulation of the immune response

" ,,J.,,J.,Current Allergy and Asthma Reports,9;353-359, and this

helped me understand why you believe in using Cromolyn sodium (a mast cell

stabilizer) as well as a topical corticosteroid.

> > > >

> > > > Has anyone considered adding citric or acetic acid to a saline

> nasal

> > > wash containing 1% baby shampoo.I am considering acetic acid

> basically

> > > trying to mimic CAZS (Citric acid/zwitterionic surfactant) that Dr.

> > > Desrosiers has been studying. " The citric acid sequesters the Ca ion

> of

> > > the P.Aeruginosa extracellular polymeric substance structure,therby

> > > allowing the surfactant to bring the polymer into solution. " See

> The

> > > Role Of Bacterial Biofilms and the Pathophysiology of CRS,Kilty

> > > S.,Desrosiers M.,Current Allergy and Asthma reports,2008,8:227-223.

> Also

> > > 2% acetic acid solution has been shown to be antibacterial and

> > > antifungal.( used externally for ear infections).Not sure whether

> this

> > > high would even be necessary or tolerable in a nasal wash.I am

> thinking

> > > that trying this might help with the crusting and possible fungal

> > > involvement as well as helping with any p.aerginosa or staph aureus

> > > biofilms.

> > > >

> > >

> >

>

[Guest guest]

Years ago Cromolyn was frequently recommended by doctors. I used Cromolyn

nasal spray as my only treatment for a two year period, from 1996 to 1997,

with no noticeable results. This was disappointing to me because all of my

research on cromolyn appeared promising. Please keep us updated on your

results with mucomyst and cromolyn.

Re: re; Irrigation with baby shampoo

Thanks Asfy for your references with N-acetycysteine (mucomyst ampules),I

will try to get mucomyst and cromyln sodium (as in Intal capsules) fom my

M.D.. I was reading " Mast Cell Modulation of the immune response

" ,,J.,,J.,Current Allergy and Asthma Reports,9;353-359, and

this helped me understand why you believe in using Cromolyn sodium (a mast

cell stabilizer) as well as a topical corticosteroid.

,>

> Another idea would be to irrigate pure N-acetylcysteine (available in

> Mucomyst ampules) to depolymerize the biofilm matrix, and a half-hour

> later irrigate an antibiotic (Mupirocin, etc), as in :

>

> Pol J Microbiol. 2009;58(

>

>

>

[Guest guest]

,

it may be that a simple spray did not allow for sufficient distribution of the

cromolyn inside the nasal fossa.

,>

> > Another idea would be to irrigate pure N-acetylcysteine (available in

> > Mucomyst ampules) to depolymerize the biofilm matrix, and a half-hour

> > later irrigate an antibiotic (Mupirocin, etc), as in :

> >

> > Pol J Microbiol. 2009;58(

> >

> >

> >

>

[Guest guest]

Wayne,

Do note that you will have to experiment with the dose ; I found a small dose of

sodium cromoglycate (5mg/nebulization, bid) efficient, but it takes a week to

show good effect ; on the other hand, the recommended dose (20mg/nebulization,

bid or tid) was too strong and gave unwanted side effects. I suppose it depends

on the severity of the underlying inflammation.

> > > > >

> > > > > Has anyone considered adding citric or acetic acid to a saline

> > nasal

> > > > wash containing 1% baby shampoo.I am considering acetic acid

> > basically

> > > > trying to mimic CAZS (Citric acid/zwitterionic surfactant) that Dr.

> > > > Desrosiers has been studying. " The citric acid sequesters the Ca ion

> > of

> > > > the P.Aeruginosa extracellular polymeric substance structure,therby

> > > > allowing the surfactant to bring the polymer into solution. " See

> > The

> > > > Role Of Bacterial Biofilms and the Pathophysiology of CRS,Kilty

> > > > S.,Desrosiers M.,Current Allergy and Asthma reports,2008,8:227-223.

> > Also

> > > > 2% acetic acid solution has been shown to be antibacterial and

> > > > antifungal.( used externally for ear infections).Not sure whether

> > this

> > > > high would even be necessary or tolerable in a nasal wash.I am

> > thinking

> > > > that trying this might help with the crusting and possible fungal

> > > > involvement as well as helping with any p.aerginosa or staph aureus

> > > > biofilms.

> > > > >

> > > >

> > >

> >

>

[Guest guest]

A nasal spray only penetrates the anterior portion of the nose,probably nothing

enters the sinuses.I was researching the via nase system and don't know if it

ever was patented.I really have no idea why the big drug companies haven't

improved on this mickey mouse way of administering topical corticosteroids as it

really again only penetrates the anterior part of the nose.This is why positive

pressure irrigation or nebulization is so promising especially after surgical

opening of the sinuses.

,>

> > > Another idea would be to irrigate pure N-acetylcysteine (available in

> > > Mucomyst ampules) to depolymerize the biofilm matrix, and a half-hour

> > > later irrigate an antibiotic (Mupirocin, etc), as in :

> > >

> > > Pol J Microbiol. 2009;58(

> > >

> > >

> > >

> >

>

[Guest guest]

Asfy, I do not have a nebulizer but as you know use the Neil Med system ,would

the dosage basically be the same as what you are recommending?I thank you as

always for your guidance.

> > > > > >

> > > > > > Has anyone considered adding citric or acetic acid to a saline

> > > nasal

> > > > > wash containing 1% baby shampoo.I am considering acetic acid

> > > basically

> > > > > trying to mimic CAZS (Citric acid/zwitterionic surfactant) that Dr.

> > > > > Desrosiers has been studying. " The citric acid sequesters the Ca ion

> > > of

> > > > > the P.Aeruginosa extracellular polymeric substance structure,therby

> > > > > allowing the surfactant to bring the polymer into solution. " See

> > > The

> > > > > Role Of Bacterial Biofilms and the Pathophysiology of CRS,Kilty

> > > > > S.,Desrosiers M.,Current Allergy and Asthma reports,2008,8:227-223.

> > > Also

> > > > > 2% acetic acid solution has been shown to be antibacterial and

> > > > > antifungal.( used externally for ear infections).Not sure whether

> > > this

> > > > > high would even be necessary or tolerable in a nasal wash.I am

> > > thinking

> > > > > that trying this might help with the crusting and possible fungal

> > > > > involvement as well as helping with any p.aerginosa or staph aureus

> > > > > biofilms.

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Wayne,

I have also tried irrigation with (DSCG 5mg + saline qsp one " nose full " ie

approx 20ml) tid - after one rinse of regular saline irrigation to clear out the

mucus beforehand - and found it helpful after a couple of days. Again, the

appropriate dose has to be determined by trial and error according to the

inflammation level. The major characteristic of DSCG is that it has a short

half-life, hence the tid ; it protects best pre-inflammation, far less as rescue

medication.

>

>

> Asfy, I do not have a nebulizer but as you know use the Neil Med system ,would

the dosage basically be the same as what you are recommending?I thank you as

always for your guidance.