Antimicrobials and chronic rhinosinusitis with or without polyposis in adults: An evidenced-based review with recommendations

Zachary M. Soler, Samuel L. Oyer, Robert C. Kern, Brent A M Senior, Stilianos E. Kountakis, Bradley F. Marple, Timothy Smith

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Background: Chronic rhinosinusitis (CRS) is characterized by inflammation of the mucosa of the nose and paranasal sinuses. The role of bacterial or fungal infection in CRS is unclear, yet antimicrobials are commonly prescribed for this condition. Published guidelines offer little direction regarding antibiotic strategies for CRS. The purpose of this article is to provide an evidence-based approach to the use of antibacterial and antifungal antibiotics in the management of CRS. Methods: A systematic review of the literature was performed following recommendations of the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE). Inclusion criteria were: age ≥18 years old, chronic rhinosinusitis with or without polyps, antibiotic treatment as the experimental group, and clearly defined primary clinical endpoint. Studies involving patients with cystic fibrosis or acute invasive fungal sinusitis were excluded. Results: The review identified and evaluated the literature on 8 classes of antimicrobials for CRS: oral antibacterial antibiotics ≤3 weeks, oral antibacterial antibiotics >3 weeks, macrolide antibiotics, intravenous antibacterial antibiotics, topical antibacterial antibiotics, oral antifungals, intravenous antifungals, and topical antifungals. Conclusion: Based on the available evidence, oral antibacterial antibiotics and prolonged macrolide antibiotics are considered therapeutic options in the treatment of CRS while the use of topical antibacterial antibiotics, intravenous antibacterial antibiotics and oral, topical, or intravenous antifungals would be recommended against. These evidence-based recommendations should not necessarily be applied to all patients with CRS and are not intended to supersede clinical judgment based on individual patient circumstances.

Original languageEnglish (US)
Pages (from-to)31-47
Number of pages17
JournalInternational Forum of Allergy and Rhinology
Volume3
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Anti-Bacterial Agents
Antifungal Agents
Macrolides
Guidelines
Mycoses
Paranasal Sinuses
Sinusitis
Polyps
Nose
Practice Guidelines
Bacterial Infections
Cystic Fibrosis
Mucous Membrane
Therapeutics
Inflammation

Keywords

  • Antibiotics
  • Antifungals
  • Chronic rhinosinusitis
  • Evidence-based medicine
  • Macrolides

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

Cite this

Antimicrobials and chronic rhinosinusitis with or without polyposis in adults : An evidenced-based review with recommendations. / Soler, Zachary M.; Oyer, Samuel L.; Kern, Robert C.; Senior, Brent A M; Kountakis, Stilianos E.; Marple, Bradley F.; Smith, Timothy.

In: International Forum of Allergy and Rhinology, Vol. 3, No. 1, 01.2013, p. 31-47.

Research output: Contribution to journalArticle

Soler, Zachary M. ; Oyer, Samuel L. ; Kern, Robert C. ; Senior, Brent A M ; Kountakis, Stilianos E. ; Marple, Bradley F. ; Smith, Timothy. / Antimicrobials and chronic rhinosinusitis with or without polyposis in adults : An evidenced-based review with recommendations. In: International Forum of Allergy and Rhinology. 2013 ; Vol. 3, No. 1. pp. 31-47.
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abstract = "Background: Chronic rhinosinusitis (CRS) is characterized by inflammation of the mucosa of the nose and paranasal sinuses. The role of bacterial or fungal infection in CRS is unclear, yet antimicrobials are commonly prescribed for this condition. Published guidelines offer little direction regarding antibiotic strategies for CRS. The purpose of this article is to provide an evidence-based approach to the use of antibacterial and antifungal antibiotics in the management of CRS. Methods: A systematic review of the literature was performed following recommendations of the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE). Inclusion criteria were: age ≥18 years old, chronic rhinosinusitis with or without polyps, antibiotic treatment as the experimental group, and clearly defined primary clinical endpoint. Studies involving patients with cystic fibrosis or acute invasive fungal sinusitis were excluded. Results: The review identified and evaluated the literature on 8 classes of antimicrobials for CRS: oral antibacterial antibiotics ≤3 weeks, oral antibacterial antibiotics >3 weeks, macrolide antibiotics, intravenous antibacterial antibiotics, topical antibacterial antibiotics, oral antifungals, intravenous antifungals, and topical antifungals. Conclusion: Based on the available evidence, oral antibacterial antibiotics and prolonged macrolide antibiotics are considered therapeutic options in the treatment of CRS while the use of topical antibacterial antibiotics, intravenous antibacterial antibiotics and oral, topical, or intravenous antifungals would be recommended against. These evidence-based recommendations should not necessarily be applied to all patients with CRS and are not intended to supersede clinical judgment based on individual patient circumstances.",
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