IJOHNS  Vol.4 No.1 , January 2015
Antibiotic Treatment for Chronic Rhinosinusitis after Endoscopic Surgery: How Long Should Macrolide Antibiotics Be Given?
ABSTRACT
Background: The purpose of this study was to determine an appropriate period for macrolide antibiotic therapy, and to investigate whether this period could be shorter, for patients with chronicrhino sinusitis (CRS) after functional endoscopic sinus surgery (FESS). Methods: A retrospective analysis of 41 patients undergoing FESS for CRS was performed. All patients underwent pre-operative computed tomography (CT). Patients with fungal sinusitis, allergic fungal sinusitis, and eosinophilic sinusitis were excluded. After FESS, normalized sinus mucosa was confirmed by CT and endoscopy in all patients. Postoperative antibiotic therapy consisted of first-line and second-line regimens. Garenoxacin (GRNX), or clarithromycin (CAM, 400 mg/day) was used as the first-line regimens and low-dose macrolide therapy (CAM, 200 mg/day) was used as the second-line regimen and was prescribed at outpatient visits based on our clinical criteria. Results: Second-line antibiotic therapy (low-dose CAM) was not necessary in 12 of 41 (29%) patients, while it was prescribed in 29 of 41 (71%). The mean duration of low-dose CAM therapy after FESS was 36 days (range 7 to 122 days; median, 25 days). Patients who received second-line therapy (n = 29) were divided into two groups based on the choice of first-line therapy, a GRNX group (n = 13) and a non-GRNX group (n = 16). Those in the non-GRNX had longer periods of postoperative CAM therapy than those in the GRNX group. Conclusion: GRNX was associated with a shorter duration of low-dose macrolide therapy after FESS, and 29% of patients did not need any low-dose macrolide therapy postoperatively. Therefore, macrolide antibiotics should not be routinely prescribed after FESS.

Cite this paper
Sawatsubashi, M. , Murakami, D. and Komune, S. (2015) Antibiotic Treatment for Chronic Rhinosinusitis after Endoscopic Surgery: How Long Should Macrolide Antibiotics Be Given?. International Journal of Otolaryngology and Head & Neck Surgery, 4, 44-49. doi: 10.4236/ijohns.2015.41008.
References
[1]   Bandhauer, F., Buhl, D. and Grossenbacher, R. (2002) Antibiotic Prophylaxis in Rhinosurgery. American Journal of Rhinology, 16, 135-139.

[2]   Cervin, A. and Wallwork, B. (2007) Macrolide Therapy of Chronic Rhinosinusitis. Rhinology, 45, 259-267.

[3]   Moriyama, H., Yanagi, K., Ohtori, N. and Fukami, M. (1995) Evaluation of Endoscopic Sinus Surgery for Chronic Sinusitis: Post-Operative Erythromycin Therapy. Rhinology, 33, 166-170.

[4]   Nakamura, Y., Suzuki, M., Yokota, M., Ozaki, S., Ohno, N., et al. (2013) Optimal Duration of Macrolide Treatment for Chronic Sinusitis after Endoscopic Sinus Surgery. ANS, 40, 366-372.

[5]   Shikani, A.H. (1996) Use of Antibiotics for Expansion of the Merocel Parking Following Endoscopic Sinus Surgery. Ear, Nose Throat Journal, 75, 524-526.

[6]   Bhattacharyya, N. and Kepnes, L.J. (2008) Assessment of Trends in Antimicrobial Resistance in Chronic Rhinosinusitis. Annals of Otology, Rhinology Laryngology, 117, 448-452.
http://dx.doi.org/10.1177/000348940811700608

[7]   Lund, V.J. and Mackay, I.S. (1993) Staging in Rhinosinusitis. Rhinology, 107, 183-184.

[8]   Kennedy, D.W., Zinreich, S.J., Shaalan, H., Kuhn, F., Naclerio, R., Loch, E.L. (1987) Endoscopic Middle Meatal Antrostomy: Theory, Technique, and Patency. Laryngoscope, 97, 1-9.
http://dx.doi.org/10.1288/00005537-198708002-00001

[9]   Bandhauer, F., Buhl, D. and Grossenbacher, R. (2002) Antibiotic Prophylaxis in Rhinosurgery. American Journal of Rhinology, 16, 135-139.

[10]   Japan Rhinologic Society (2013) Japanese Guideline for Chronic Sinusitis. Vol. 4, Kanehara, Tokyo, 50-60.

[11]   Albu, S. and Lucaciu, R. (2010) Prophylactic Antibiotics in Endoscopic Sinus Surgery: A Short Follow-Up Study. American Journal of Rhinology Allergy, 24, 306-309.
http://dx.doi.org/10.2500/ajra.2010.24.3475

[12]   Jiang, R.S., Liang, K.L., Yang, K.Y., Shiao, J.Y., Su, M.C., et al. (2008) Postoperative Antibiotic Care after Functional Endoscopic Sinus Surgery. American Journal of Rhinology, 22, 608-612. http://dx.doi.org/10.2500/ajr.2008.22.3241

[13]   Bhandarkar, N.D., Mace, J.C. and Smith, T.L. (2011) Endoscopic Sinus Surgery Reduces Antibiotic Utilization in Rhinosinusitis. International Forum of Allergy Rhinology, 1, 18-22.

[14]   Takahata, M., Shimakura, M., Hori, R., Kizawa, K., Todo, Y., et al. (2001) In Vitro and in Vivo Antimicrobial Activities of T-3811ME (BMS-284756) against Mycoplasma Pneumonia. Antimicrobial Agents and Chemotherapy, 45, 312-315. http://dx.doi.org/10.1128/AAC.45.1.312-315.2001

[15]   Ito, M., Maruyama, Y., Murono, S., Wakisaka, N., Kondo, S., et al. (2012) Efficacy and Safety of Garenoxacin in the Treatment of Upper Respiratory Tract Infections. ANL, 39, 512-518.

 
 
Top