Oral antibiotics and the management of chronic sinusitis: what do we know?

Chronic rhinosinusitis affected 12.5% of the general population in the United States, making it one of the most common causes for patients to seek medical care. Despite a lack of compelling evidence, antibiotics are the most frequently prescribed class of medications for the treatment of chronic sinusitis, demonstrating a deeply rooted belief that bacteria are in some way responsible for the disease.

Despite the high prevalence of sinusitis, the cause of chronic rhinosinusitis remains elusive despite multiple attempts to determine the underlying cause. Theories have come and gone throughout the years with fungi, bacteria, host immunological defects, allergy, structural and functional defects, gastroesophageal reflux disease, environmental chemicals, and bacterial biofilms being blamed for this chronic inflammatory state of the sinonasal mucosa. Recent literature has continued to explore these various theories.

To date, there is no high-quality evidence that antibiotic therapy has any effect on the long-term management of chronic rhinosinusitis. No randomized placebo-controlled studies evaluating the utility of antibiotics have as yet been conducted. There remains an urgent need for a high-quality, prospective clinical trial to determine the proper role of antibiotics in the treatment of chronic rhinosinusitis.