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AimThis study sought to investigate the efficacy of keigairengyoto (KRT, TJ‐50), a Japanese traditional medicine, in the regulation of bacterial infections and treatment of chronic rhinosinusitis.MethodsPatients undergoing endoscopic sinus surgery (ESS) were randomized into two groups: one receiving low‐dose macrolide (n = 13) and the other concurrent KRT (n = 9) for 12 weeks. They were evaluated by Sino‐Nasal Outcome Test‐22 (SNOT‐22), an olfactory survey based on a visual analog scale and bacteria survey. The type of bacteria and number of colony‐forming units were examined 12 weeks after the ESS.ResultsBoth groups showed improvement in the total SNOT‐22 score and olfactory survey. The increase in the number of bacteria was clearly suppressed in the KRT group as compared with the non‐KRT group.ConclusionKRT appears to be a promising agent for the regulation of bacterial growth during postoperative treatment for chronic sinusitis.