Systemic Antibiotics for Chronic Rhinosinusitis

Summary

A Cochrane review [Abstract] 1 included 5 studies with a total of 293 subjects. Four studies recruited only adults and one only children. Three used macrolide, one tetracycline and one a cephalosporin-type antibiotic. Three recruited patients with chronic rhinosinusitis without nasal polyps, one patients with chronic rhinosinusitis with nasal polyps and one had a mixed population. Three followed up patients for 10 to 12 weeks after treatment had finished.

• Systemic antibiotics vs. placebo:One study (n=64, without polyps) reported disease-specific HRQL using the SNOT-20 (0 to 5, 0 = best quality of life). At the end of treatment (3 months) the SNOT-20 score was lower in the macrolide than in the placebo group (MD -0.54 points, 95% CI -0.98 to -0.10), favouring antibiotics. Three months after treatment it is uncertain if there was any difference between the groups.Based on one study (n=33, with polyps), it is uncertain if antibiotics were associated with an increase in GI disturbances (RR 1.36, 95% CI 0.22 to 8.50) orskin irritation (RR 6.67, 95% CI 0.34 to 128.86).
• Systemic antibiotics plus saline irrigation and intranasal corticosteroids vs. placebo plus saline irrigation and intranasal corticosteroids:One study (n=60, with and without polyps) compared a 3-month course of macrolide with placebo; all patients also used saline irrigation and 70% used intranasal corticosteroids. Using disease-specific HRQL SNOT-22, it is unclear if there were differences at any time point. Patients rated the effect of treatment on a 5-point scale at the end of treatment (3 months). For improvement in symptoms there was no difference between the groups (RR 1.50, 95% CI 0.81 to 2.79), although there were few more people who felt worse after the antibiotics. There were no differences in the rate of GI disturbances between the groups (RR 1.07, 95% CI 0.16 to 7.10). There was no difference in general HRQL between the groups at the end of treatment (12 weeks) or 2 weeks later.
• Systemic antibiotics vs. intranasal corticosteroids:One study (n=43, without polyps) compared a 3-month course of macrolide with intranasal corticosteroids. The patient-reported disease severity was similar between the groups (MD -0.32, 95% CI -2.11 to 1.47).
• Systemic antibiotics vs. oral corticosteroids:One study (n=28, with polyps) compared a short course of tetracycline antibiotic (approximately20 days) with a 20-day course of oral corticosteroids. It was not possible to extract data on any of the primary efficacy outcomes. It is uncertain if there was a difference in GI disturbances (RR 1.00, 95% CI 0.16 to 6.14) or skin irritation (RR 2.00, 95% CI 0.20 to 19.62).