Background: Management of allergic fungal sinusitis after surgery is difficult and prolonged steroid use has significant side effects and there are a group of patients who are unresponsive to standard treatment with corticosteroid. Other modalities are suggested as adjunct to steroid in the treatment of AFRS including Oral itraconazole which is an antifungal agent that seems to be benefit to patients with AFS. Aim of the work: The aim of the present study is to study the effect of post-operative use of systemic Itraconazole as an adjunct to local steroids in management of patients of Allergic fungal rhino sinusitis. Patients and methods: This prospective study was conducted in Otorhinolaryngology Department, Faculty of Medicine, Zagazig University. This study included 18 patients with AFRS met the inclusion and exclusion criteria in our study. Results: In our study there was no statistically significant difference in the affected nasal sinus between the two studied groups, there was statistically significant decrease in IgE post-operatively in both groups. there was no statistically significant difference preoperatively and six month post-operative in both groups. Conclusion: Systemic Itraconazole can be considered as an effective treatment alternative to the systemic steroid for postoperative management of AFRS, especially when there is intolerance, decrease response or contraindication to system steroid .