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

The entire group of patients lowered their Lund-McKay scores from 9.90 at baseline to 6.76 at the end of the six weeks. That difference was also statistically significant, he said.

Dr. Dubin said that 7 of 19 patients normalized their sinus condition after three weeks of maximal medical treatment. However, another two patients were able to clear their infections with an addition three weeks of medical therapy.

Some May Benefit from Longer Course, but Questions Remain

There are patients who improve and radiographically clear disease with six instead of three weeks of antibiotics, Dr. Dubin said. Therefore, maximal medical therapy for chronic sinusitis may require six weeks of antibiotics to ensure maximal benefit.

He did note, however, that 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. He suggested that doctors might have been witnessing a natural radiographic progression of chronic sinusitis.

The co-moderator of the session, Ramzi Younis, MD, Associate Professor of Otolaryngology and Pediatrics at the University of Miami School of Medicine (Fla.), said that a control group might have been useful in sorting out those issues. He also suggested that dosing patients with clindamycin 150 mg twice a day might be a more useful protocol.

Dr. Dubin acknowledged that controlled clinical trials will be required to answer a number of questions raised by his trial, including how long antibiotics should be delivered to patients with chronic sinusitis, optimal antibiotic choice for chronic sinusitis, and the role of adjunctive therapies, including the use of oral steroids in patients with chronic sinusitis.

©2006 The Triological Society