The Impact of Antibiotics and Steroids on the Nasal Microbiome in Patients with Chronic Rhinosinusitis: A Systematic Review According to PICO Criteria

Abstract

Background: The nasal microbiome represents the main environmental factor of the inflammatory process in chronic rhinosinusitis (CRS). Antibiotics and steroids constitute the mainstay of CRS therapies. However, their impact on microbial communities needs to be better understood. This systematic review summarizes the evidence about antibiotics’ and steroids’ impact on the nasal microbiota in patients with CRS. Methods: The search strategy was conducted in accordance with the PRISMA guidelines for systematic reviews. The authors searched all papers in the three major medical databases (PubMed, Scopus, and Cochrane Library) using the PICO tool (population, intervention, comparison, and outcomes). The search was carried out using a combination of the key terms “Microbiota” or “Microbiome” and “Chronic Rhinosinusitis”. Results: Overall, 402 papers were identified, and after duplicate removal (127 papers), excluding papers off-topic (154) and for other structural reasons (110), papers were assessed for eligibility; finally, only 11 papers were included and summarized in the present systematic review. Some authors used only steroids, other researchers used only antibiotics, and others used both antibiotics and steroids. With regard to the use of steroids as exclusive medical treatment, topical mometasone and budesonide were investigated. With regard to the use of antibiotics as exclusive medical treatments, clarithromycin, doxycycline, roxithromycin, and amoxicillin clavulanate were investigated. Regarding the use of both antibiotics and steroids, two associations were investigated: systemic prednisone combined with amoxicillin clavulanate and topical budesonide combined with azithromycin. Conclusions: The impact that therapies can have on the nasal microbiome of CRS patients is very varied. Further studies are needed to understand the role of the nasal microbiome, prevent CRS, and improve therapeutic tools for personalized medicine tailored to the individual patient.

Long-Term Perspectives on Chronic Rhinosinusitis with Nasal Polyps: Evaluating Recurrence Rates after Functional Endoscopic Sinus Surgery in the Biologics Era—A 5-Year Follow-Up Study

“…Additionally, there is no statistical significance of association between BMI and the risk of recurrence, in contrast to other studies that hypothesize an etiopathological correlation between CRS, metabolic syndrome, and visceral obesity due to the secretion of proinflammatory mediators, such as cytokines and adipokines from excess adipose tissue [46]. Concerning the smoking habit, which has an established correlation with the occurrence of CRS due to tobacco-induced bacterial biofilm formation [4] and the irritating and immunosuppressive effects of smoking on sinonasal mucosal cells [47], no significant correlation with recurrence was found (p = 0.551) in our study.…”

“…CRSwNP is mainly characterized by inflammation of the mucosa of the nose and paranasal sinuses and tissue remodeling. Environmental and host genetic factors interact over time to trigger one or more pathways (endotypes) of chronic inflammation that lead to the clinical presentation of CRSwNP (phenotype) [ 3 , 4 ].…”

Real-Life Evidence of Mepolizumab Treatment in Chronic Rhinosinusitis with Nasal Polyps: A Multicentric Study

“…This chronic inflammatory condition is often severe and has a significant negative impact on patients’ sleep and physical and mental status, resulting in impaired health-related quality of life (QoL) comparable to that of other debilitating chronic diseases, such as chronic obstructive pulmonary disease (COPD), diabetes, asthma, and congestive heart failure [ 26 ]. CRSwNP in the Caucasian population is typically eosinophilic, driven by type 2 cytokines such as interleukin (IL)-4, IL-5, and IL-13 [ 27 ], resulting in symptoms of nasal obstruction, nasal discharge, facial pain or facial pressure and loss of smell for at least twelve weeks [ 28 ]. Specifically, the type 2 inflammatory pathway is associated with inflammatory diseases that include not only CRSwNP but also asthma, non-steroidal anti-inflammatory drug exacerbated respiratory disease (NSAID–ERD), eosinophilic COPD, allergic rhinitis, atopic dermatitis, chronic prurigo, chronic urticaria and eosinophilic esophagitis [ 29 , 30 ].…”