Intravenous Antibiotics for Refractory Rhinosinusitis in Nonsurgical Patients: Preliminary Findings of a Prospective Study

Abstract

Home i.v. antibiotics provide an excellent alternative to surgery for patients who have either had unsuccessful surgery or who have refused surgery.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…Moreover, the long-term outcomes of macrolide-treated patients are not entirely known, with some evidence showing a lack of permanent effect. The efficacy of macrolides appear to differ by CRS phenotype, so that additional work will need to be performed in order to better clarify the balance between benefit and harm of macrolide therapy in CRSsNP (Table VII- 771 reported an observational cohort of 45 nonsurgical patients, diagnosed with osteitis of the paranasal sinuses on CT scans. All patients were treated with culture-directed antibiotics for a period of 6 weeks.…”

Hyperostotic Chronic Sinusitis as an Indication for Outpatient Intravenous Antibiotics

“…• Hyperostosis-diffuse bony thickening due to chronic inflammatory infiltrate , bony resorption, and osteoneogenesis •This cycle of resorption, osteoneogenesis, and fibrosis in setting of chronic sinusitis is similar to that observed in osteomyelitis 1 •The orthopedic literature had demonstrated intravenous antibiotics as the cornerstone of long bone osteomyelitis treatment •It has been shown that there is a significant improvement in symptoms at week 15 after 2 weeks of pre-operative IV antibiotics, followed by surgery, than 6 weeks of post operative antibiotics 2 •Intravenous antibiotics for 6 weeks in 45 patients who refused surgery also showed significant symptom improvement 3 •The reported success of endoscopic sinus surgery is greater than 80% 4 , despite this there remain patients that fail surgical cure •We thus hypothesize that a combination of intravenous antibiotics following surgery will improve patient outcomes in those with hyperostotic sinusitis •Herein we review the role of intravenous antibiotics following surgery for patients with hyperostotic sinusitis versus surgery followed by traditional treatment with courses of oral antibiotics, irrigations, and steroids …”

Inflammatory sinonasal disease

“…Appropriate medical therapy will result in the control of symptoms in about 80% of patients with CRS [63]. The failure of medical therapy in a significant number of patients, however, has resulted in the use of novel therapies for CRS, including nebulized intranasal antibiotics [64], intranasal antifungal irrigations [65], intravenous immune globulin injections [66], and intravenous antibiotic therapy [67]. Whether any of these novel therapies will significantly affect the course of CRS has yet to be determined.…”