Systemic and topical antibiotics for chronic rhinosinusitis

Area of Science:

• Otolaryngology and Respiratory Medicine
• Evidence-based medicine
• Pharmacological interventions

Background:

• Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition of the nasal and sinus linings.
• Symptoms include nasal blockage, discharge, facial pain, and loss of smell, with or without nasal polyps.
• Systemic and topical antibiotics are used to manage infection and inflammation in CRS.

Purpose of the Study:

• To evaluate the efficacy and safety of systemic and topical antibiotic treatments for chronic rhinosinusitis.
• To assess effects on quality of life, disease severity, and adverse events.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) with a minimum three-month follow-up.
• Searched multiple databases including Cochrane ENT Trials Register, CENTRAL, MEDLINE, and EMBASE.
• Primary outcomes: disease-specific health-related quality of life (HRQL), patient-reported disease severity, and gastrointestinal disturbance.

Main Results:

• Five RCTs (293 participants) compared systemic antibiotics to placebo or other interventions; no topical antibiotic RCTs met criteria.
• Moderate evidence showed a modest, short-term improvement in disease-specific HRQL for adults without polyps using macrolide antibiotics.
• Evidence regarding other outcomes, including adverse events like gastrointestinal disturbances, was often of very low or low quality and uncertain.

Conclusions:

• Limited evidence supports the effectiveness of systemic antibiotics for chronic rhinosinusitis.
• A modest, temporary quality of life improvement was observed in specific patient subgroups (adults without polyps).
• Further research is needed to clarify long-term outcomes and adverse effects of antibiotic use in CRS.