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

The patients were admitted for treatment of chronic sinusitis between September 1, 2004 and June 1, 2005. In order to be eligible for the medical protocol, patients had to be naïve to major sinusitis surgery in the past. Doctors also performed a CT examination to be certain that the patients had inflammatory disease at the initial visit.

Drug Choices

If a culture indicated the particular bacteria that was causing the disease, the antibiotic most useful for combating that species was employed. Otherwise, the patients were treated with oral clindamycin 150 mg three times a day. If the patient was intolerant of clindamycin or suffered an allergic reactions to the drug, ampicillin/sulbactam was substituted.

The patients were not prescribed additional mucolytics, oral steroids, or topical steroids, but if the patients were already on these agents they were not taken off of them. The average patient had gone through 3.3 courses of antibiotic therapy before entering the study and had spent an average of 4.6 weeks on antibiotic therapy in attempts to cure their chronic sinusitis.

Of the 41 patients with confirmed chronic sinusitis, 19 completed all six weeks of therapy and received all three CT scans. CT’s were then retrospectively graded by the Lund-MacKay staging system. Nineteen of the original patients did not receive a scan at three weeks and three other patients did not complete the six weeks of antibiotics.

It was possible that the individuals who improved after three weeks of antibiotic treatment might have gotten better if their treatment after the first three weeks of antibiotics had instead simply been observation for three weeks.

Of the patients who had all three scans and completed all six weeks of antibiotics, 15 were on clindamycin, three were taking amoxicillin and clavulanic acid (Augmentin), and one was on doxycycline. In addition, one person was taking oral steroids to control asthma, two were on antihistamines, three were using intranasal steroids, and four patients were on leukotriene inhibitors.

Results Show Improvement

These patients began the trial with a Lund-McKay score of greater than five, with five representing normal function. The average score of the 19 patients who completed all aspects of the study was 9.90; this was the same average as all 41 patients at baseline, Dr. Dubin said.

After three weeks, the 19 patients who fulfilled the protocol had Lund-McKay scores that averaged 5.68; after six weeks those scores averaged 5.90. The differences from baseline were statistically significant, Dr. Dubin said.