Evidence Is Lacking for Use of Oral Antibiotics in Rhinosinusitis

Despite being commonly prescribed, experts have found very little evidence to support the use of oral antibiotics for allergic and chronic rhinosinusitis.

Instead, intranasal corticosteroids and topical saline should remain first-line treatments for all forms of rhinosinusitis, and antibiotic therapies should be used judiciously.¹

Rhinosinusitis is a common condition with significant costs to the health care system and patients.

Multiple options are available for treating acute and chronic rhinosinusitis, but there are significant challenges in choosing the appropriate therapy, according to a perspective published in Expert Opinion on Pharmacotherapy.

Symptoms must include discolored nasal secretions and dental or facial tenderness to warrant antibiotics, according to the American Academy of Family Physicians.² Studies comparing antibiotics with a placebo have found that, regardless of which treatment patients received, most symptoms improved within 2 weeks.²

Although biologic therapies are not approved for chronic rhinosinusitis, the investigators said they do show promise as a means of individualizing endotype-driven therapy in the future.

Similarly, precision medicine allows for the stratification of patients with chronic rhinosinusitis into different treatment arms according to disease profile, which could further

guide treatments.¹

Despite guideline-directed use of pharmacotherapy, the investigators said that up to one-third of patients with chronic rhinosinusitis will experience persistent disease.¹

REFERENCES

• Psaltis A, Vyskocil E. What are the challenges in choosing pharmacotherapy for rhinosinusitis? Expert Opinion on Pharmacotherapy; January 14, 2020. https://www.tandfonline.com/doi/full/10.1080/14656566.2020.1717467?scroll=top&needAccess=true. Accessed July 14, 2020.
• Antibiotics for Sinusitis. American Academy of Family Physicians website; https://www.aafp.org/patient-care/clinical-recommendations/all/cw-sinusitis.html. Accesed July 14, 2020.