Compounded Nasal Antimicrobial Sprays (BEG/BEGI, Amphotericin, Colloidal Silver)

Also known as: BEG spray (mupirocin/EDTA/gentamicin), BEGI (adds itraconazole), amphotericin B nasal, colloidal silver nasal

Other

In plain English

These are custom nasal sprays/rinses used for hard-to-treat chronic sinus infections, usually after sinus surgery and standard treatments have failed. They deliver antibiotics (mupirocin, gentamicin) — sometimes with an antifungal (itraconazole/amphotericin) or colloidal silver — directly into the nose. The evidence is limited: guidelines do not recommend routine topical antibiotics/antifungals for ordinary chronic sinusitis, and colloidal silver in particular lacks proven benefit and can cause permanent skin discoloration (argyria). They are best reserved for specialist-directed, culture-guided use.

The science

In recalcitrant chronic rhinosinusitis, high-volume culture-directed topical antibiotic irrigations (e.g., mupirocin for Staphylococcus aureus) can transiently reduce bacterial load, and small studies show short-term benefit for staphylococcal disease; EDTA is added as an antibiofilm/chelating adjunct. Evidence-based reviews, however, recommend against routine topical antibiotics (especially by nebulizer/spray) and against topical antifungals (amphotericin) for typical CRS, reserving them for post-surgical, refractory, culture-positive cases. Colloidal silver has antimicrobial activity in vitro but no quality clinical evidence for sinusitis.

References

• Rudmik L et al., topical therapies in chronic rhinosinusitis (evidence-based review), Int Forum Allergy Rhinol 2013
• Huang Z et al./ topical antibiotic therapy in chronic rhinosinusitis: an update (systematic review), 2019