Endoscopic culture-directed antibiotic therapy: Impact on patient symptoms in chronic rhinosinusitis

Comparison of outcomes following culture‐directed vs non–culture‐directed antibiotics in treatment of acute exacerbations of chronic rhinosinusitis

“…In a study by Zhang et al., only 7% of patients treated empirically with trimethoprim/sulfamethoxazole and clindamycin were found to have culture‐inappropriate antibiotics. This is far less than 2 other studies that reported a 51.4% and 77% change in antibiotics based on culture results . In our study, we do not know how many of the empirically prescribed antibiotics patients received culture‐inappropriate antibiotics.…”

“…Although it has been suggested that antibiotics may not change the clinical course of disease, expert opinion and consensus guidelines have favored the use of short‐term antibiotics for acute CRS exacerbations in the setting of a positive culture . Endoscopic‐guided cultures and use of culture‐directed antibiotics result in improved sinonasal symptoms and QOL outcome scores, although this has not been directly compared to empiric antibiotics . In previous studies, patients treated with culture‐ inappropriate antibiotics (eg, those not covered by culture sensitivity profiles) have decreased QOL improvement compared to those treated with culture‐appropriate antibiotics, but this difference was no longer apparent at 6‐month follow‐up …”

“…The implications of a positive sinus culture remain unclear as single‐organism growth may not represent disease causality. Emerging research in the sinus microbiome has shown a predominance of Staphylococcus aureus and Pseudomonas bacteria in CRS patients but also the presence of a wide polymicrobial variety . Treatment with culture‐directed antibiotics decreases the abundance of the sinus microbiome, but its effect on species diversity is also debated .…”

Are multiple sinus cultures necessary during sinus surgery for chronic rhinosinusitis?

“…The nasal microbiome is important for innate immunity and studies have suggested that dysregulation of natural nasal flora by bacteria such as Staphylococcus aureus and Pseudomonas may play a role in persistence of rhinosinusitis . Although the use of antibiotics in CRS is at the discretion of the practitioner, the role of endoscopic‐guided cultures and culture‐directed antibiotics and the benefit on quality of life outcomes have been demonstrated . Additionally, Zhang et al.…”

A call for critical examination of endoscopically guided cultures in chronic rhinosinusitis

“…As such, it is not clear whether cultures truly offer this presumed information (ie, testing in‐vivo antibiotic resistance), and perhaps molecular analyses of the sample may prove more reliable in the future. Two groups have reported that utilizing endoscopically guided cultures changed the choice of antibiotic in 66% to 77% of the time . Currently, however, there are no data examining the additional benefit conferred by culture‐directed antibiotic use over empiric antibiotic selection in CRS.…”