Is greater antibiotic therapy prior to ESS associated with differences in surgical outcomes in CRS?

Abstract

Objective Antibiotics have been a mainstay of chronic rhinosinusitis therapy; however, data suggest that antibiotics may also result in several adverse unintended consequences. We aimed to evaluate if greater antibiotic use prior to sinus surgery was associated with differences in surgical outcomes. Methods Adult CRS patients enrolled in a prospective, multi‐institutional, observational cohort study were asked to recall systemic antibiotic use in the 90 days prior to endoscopic sinus surgery (ESS). Antibiotic use was examined in relation to demographics, disease characteristics, and outcomes. Results Data were collected for 271 study participants followed for a mean of 14.9 [± 5.1] months across four institutions, with a mean preoperative antibiotic use of 27.8 [± 22.7] days out of the 90 preceding ESS. After ESS, significant improvement (P < 0.001) was reported for patient‐reported outcome measures and endoscopy scores for the overall cohort. No bivariate correlation between preoperative antibiotic use and degree of benefit in objective clinical measures (endoscopy, Brief Smell Identification Test) was seen. Increased preoperative antibiotic use was associated with less improvement in 22‐item SinoNasal Outcome Test (SNOT‐22) and its rhinologic subdomain after ESS. Prevalence of achieving a minimal clinically important difference in overall SNOT‐22 symptom scores was lower in those using more preoperative antibiotics, although statistical significance was not reached when adjusting for independent covariates in multivariate modeling. Conclusion Higher amounts of previous antibiotic use do not appear to be associated with better ESS outcomes. Specific recommendations for antibiotic use as part of CRS‐appropriate medical therapy prior to ESS require further study, particularly given concerns for antibiotic overuse and implications for improving outcomes in the modern healthcare era. Level of Evidence 2C Laryngoscope, 129:558–566, 2019

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…One study found preoperative antibiotic use led to significantly better SNOT scores but not endoscopic scores, especially in the rhinologic subset. However, the high antibiotic dose group (more than 29 days out of 90 days prior to ESS) was relatively less improved 1961 . In addition, macrolide therapy was reported effective 1105,1121,1962 .…”

Preferences for Prophylactic Oral Antibiotic Use in Dermatologic Surgery: A Multicenter Discrete Choice Experiment

“…25,26 In contrast, 27.9% to 36.4% of respondents would choose an antibiotic that did not reduce SSI risk at all compared with no antibiotic. This decision may indicate blind preferences for antibiotics, misconceptions about improved postsurgical outcomes, 27 or a desire to ameliorate family members' or individual concerns. 25 This behavior highlights the need to improve patient education to inform accurate risk perceptions, 28 and optimize antibiotic use moving forward.…”

Validity of systemic antibiotics and systemic corticosteroid usage for chronic rhinosinusitis as metrics of disease burden

“…The need for systemic medications indicates poor disease control both because of what it may reflect (greater disease severity or AECRS) but also a direct risk of harm to the patient through the impact of side effects and adverse events. Previous study of systemic medication use for CRS has revealed novel insights into the clinical course of CRS and also revealed the use of antibiotics and oral corticosteroids for CRS is a distinct aspect of the CRS disease course (12,(34)(35)(36) . However, patient-reported, CRS-related antibiotics and oral corticosteroids usage has not been validated as a metric for CRS disease burden.…”

“…The EPOS 2012 criteria describe CRS-related systemic antibiotic usage and systemic corticosteroid usage in the prior 3 months as elements of CRS disease control. Moreover, patient-reported usage of systemic antibiotics and corticosteroids for CRS have been previously described as outcome measures in various studies (22)(23)(24)(25) . However, the frequency of patient-reported systemic antibiotic or corticosteroid usage has not been fully validated as both valid and responsive measures of CRS disease burden.…”