Short-term antibiotics treatment in patients with nasal polyps and enterotoxins producing Staphylococcus aureus strains

Abstract

Enterotoxins produced by Staphylococcus aureus (SA) can act as super-antigens and thus influence the course of chronic rhinosinusitis with nasal polyps (NP). The aim of this study was to determine if antibiotic treatment administered after endoscopic sinus surgery (ESS) for NP can positively influence the course of the disease compared to placebo. After ESS, 23 patients who tested positive, in a perioperative culture, for SA strains producing enterotoxins A-E and TSST-1, were randomized into two groups. Group A which in addition to standard treatment received oral anti-staphylococcal antibiotics for 3 weeks. Group B received a placebo. Both groups were compared preoperatively, and at 3 and 6 months after surgery using a symptom-specific score, an endoscopic score and the SNOT-22 quality of life questionnaire. Slightly better results were achieved in patients who received antibiotic therapy. However, the differences were not statistically significant. Regardless of post-operative treatment, approximately 30% of patients had a SA-negative culture 6 months after surgery.

Prevalencia de <i>Staphylococcus aureus</i> en los pacientes con rinosinusitis crónica polipoidea

“…Existen diversos estudios que tratan de demostrar la efectividad de diferentes antimicrobianos, así como disminuir el tamaño de los pólipos, mejorar la calidad de vida del paciente, reducir los síntomas obstructivos nasales o facilitar la realización de resección por cirugía endoscópica. En un estudio 11 se le administró a un grupo control fluoroquinolonas o amoxicilina con ácido clavulánico contra placebo, con el fin de contrarrestar el efecto de las enterotoxinas producidas por el S. aureus, basándose en la mejoría del SnOT-22; éstos mostraron resultados no significativos con base en una p de ≤ 0.05, pero sí hubo mejoría del SnOT-22. En otros estudios, se ha descrito que la doxiciclina administrada con una dosis de 100 mg por 20 días reduce el tamaño de los pólipos comparado con metilprednisolona y placebo.…”

Oral Antibiotics as Anti-infectives

“…There are very few studies looking at treatment of sinonasal S. aureus with oral antibiotics. One doubleblind, randomized, placebo-controlled study by Schalek et al looked at patients with CRSwNP who were culture positive for endotoxin-producing S. aureus at the time of surgery [ 10 ]. These patients were given 3 weeks of either oral antibiotics based on sensitivity (MIC) data or placebo, in addition to nasal saline irrigations and topical steroids.…”

Controversies in the treatment of chronic rhinosinusitis

“…However, the differences were not statistically significant. Regardless of postoperative treatment, approximately 30% of patients had a S. aureus-negative culture 6 months after surgery [98].…”