A prospective randomized cohort study evaluating 3 weeks vs 6 weeks of oral antibiotic treatment in the setting of "maximal medical therapy" for chronic rhinosinusitis

作者：Sreenath Satyan B; Taylor Robert J; Miller Justin D; Ambrose Emily C; Rawal Rounak B; Ebert Charles S Jr; Senior Brent A; Zanation Adam M^*

来源：International Forum of Allergy & Rhinology, 2015, 5(9): 820-828.

DOI：10.1002/alr.21542

• chronic rhinosinusitis
• maximal medical therapy
• endoscopic sinus surgery
• rhinosinusitis disability index
• chronic sinusitis survey

BackgroundSurprisingly, little literature exists evaluating the optimal duration of antibiotic treatment in maximal medical therapy for chronic rhinosinusitis (CRS). As such, we investigated whether 3 weeks vs 6 weeks of antibiotic therapy resulted in significant differences in clinical response.
MethodsA prospective, randomized cohort study was performed with patients assigned to 3-week or 6-week cohorts. Our primary outcome was failure of maximal medical therapy and surgical recommendation. Secondary outcomes included changes in pretherapy and posttherapy scores for the Rhinosinusitis Disability Index (RSDI), Chronic Sinusitis Survey (CSS), and computed tomography (CT)-based Lund-Mackay (LM) evaluation. Analyses were substratified based on presence of nasal polyps.
ResultsForty patients were randomized to the 3-week or 6-week treatment cohorts, with near-complete clinical follow-up achieved. No significant difference was found between the proportion of patients who failed medical therapy and were deemed surgical candidates between the 2 cohorts (71% vs 68%, p = 1.000). No significant difference was found in the change of RSDI or CSS scores in the 3 vs 6 weeks of treatment groups (mean standard error of the mean [SEM]; RSDI: 9.62 +/- 4.14 vs 1.53 +/- 4.01, p = 0.868; CSS: 5.75 +/- 4.36 vs 9.65 +/- 5.34, p = 0.573). Last, no significant difference was found in the change of LM scores (3.35 +/- 1.11 vs 1.53 +/- 0.81, p = 0.829).
ConclusionBased on this data, there is little difference in clinical outcomes between 3 weeks vs 6 weeks of antibiotic treatment as part of maximal medical therapy for CRS. Increased duration of antibiotic treatment theoretically may increase risk from side effects and creates higher healthcare costs.

• 出版日期2015-9