Antibiotics Show Limited Effectiveness in Eosinophilic CRS-Associated Inflammation

Are antibiotics an appropriate maximal medical therapy for the CRS subtype eosinophilic chronic rhinosinusitis (eCRS)?

Bottom line
The use of antibiotics without independent anti-inflammatory properties has limited efficacy in patients with eCRS.

Background: Advances in our understanding of the immunological processes underpinning CRS suggest that different subtypes exist. One subtype, eCRS, comprises T-helper cell type 2 (Th2) inflammation and local eosinophilic tissue infiltration, but its etiology remains elusive. Most clinicians continue to prescribe antimicrobial therapy that lacks any secondary anti-inflammatory properties for all patients with any CRS form.

Study design: Prospective individual cohort study of 39 patients presenting with CRS.

Setting: Department of Otolaryngology–Head and Neck Surgery, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey.

Synopsis: Patients had a mean age of 37.40 ± 13.45 years. Twenty-five patients were classified as eCRS and 14 as non-eCRS based on their histopathological analysis. All patients underwent endoscopic sinus surgery (ESS) after previous medical therapy. Amoxicillin–clavulanic acid was used as it is one of the most common first-line CRS antibiotic choices but does not have any known independent anti- inflammatory properties, and concomitant use of oral or topical steroids was excluded. Upon comparative analysis between the two subgroups, there were no differences with respect to asthma, aspirin hypersensitivity, or smoking. Both pre- and post-treatment Lund-Mackay, and pre-treatment Lund-Kennedy scores were significantly worse in the eCRS group compared to the non-eCRS group, whereas the Sino-Nasal Outcome Test (SNOT-22) score was comparable. Following treatment, the non-eCRS group demonstrated significant improvement in both the Lund-Mackay score and SNOT-22 score, but not the Lund-Kennedy score. The eCRS patients demonstrated improvement only in their Lund-Mackay scores. A higher number of revision surgeries and worse pre-treatment Lund-Mackay scores were found in the eCRS group.

Citation: Günel C, Bleier BS, Meteoglu I. Antibiotics in eosinophilic chronic rhinosinusitis: Rethinking maximal antimicrobial medical therapy. Laryngoscope. 2017;127:794–796.