For Chronic Sinusitis, Give Antibiotics a Longer Chance to Work Before Surgery

NAPLES, Fla.-Doctors should consider extending the course of antibiotics in patients with chronic sinusitis before giving up on conservative medical therapy and going forward to surgery, according to research presented here at the meeting of the Southern Section of the Triological Society.

In a study of maximal medical therapy in his institution, Marc Dubin, MD, Assistant Professor of Rhinology and Sinus Surgery in the Department of Otolaryngology-Head and Neck Surgery at the Johns Hopkins University School of Medicine in Baltimore, Md., determined that adding three weeks to a standard antibiotic program produced added positive results in helping patients clear the stubborn infections.

‘Failure to Respond’ Timeline Uncertain

When a patient presents with chronic sinusitis, the doctor will usually place the individual on maximal medical therapy, he said. However, Dr. Dubin suggested that exactly how long that therapy should last before the patient moves on the next therapeutic step is controversial. Failure to respond, however, represents a major criterion for proposing surgery in these patients.

Dr. Dubin looked at patients undergoing maximal medical therapy to try to get clues as to how long treatment should continue before a doctor should determine that there is failure to respond.

He noted that he had little guidance as to where to begin his study. There are no controlled studies on the length of time a patient should remain on antibiotics, nor are there any studies on what the antibiotic choice should be in chronic sinusitis. In addition, there are no studies that indicate if a combination of antibiotics is required for maximal medical therapy, he said.

Controlled clinical trials will be required to answer a number of questions raised by this trial.

Study Protocol

In his retrospective review of cases from the Georgia Nasal and Sinus Institute in Savannah, Dr. Dubin sought to objectively test whether three weeks of treatment with antibiotics was sufficient to clear chronic sinusitis or whether there was a benefit to continuing the antibiotic therapy for six weeks before determining if the patient had, indeed, failed to respond to maximal medical treatment.

There are no controlled studies on the length of time a patient should remain on antibiotics, nor are there any studies on what the antibiotic choice should be in chronic sinusitis. – -Marc Dubin, MD

The treatment progress would be tracked using computer-assisted tomography (CT) scans of the infected sinus cavity. The patients were scheduled to undergo a CT scan at baseline to confirm the disease state and then undergo follow-up scans after three weeks of treatment and after six weeks of treatment.