Antibiotics Following Sinus Surgery: Are They Needed?

Despite routine prescription, prophylactic antibiotics following endoscopic sinus surgery (ESS) do not improve patient outcomes, according to the results of a recent study.

The researchers conducted a randomized, double-blind, placebo-controlled, noninferiority trial to examine the infection rate, quality of life, and endoscopic scores in 77 adults with refractory chronic rhinosinusitis (CRS) randomized to receive either amoxicillin-clavulanate or placebo following ESS.

The researchers used the 22-item Sino-Nasal Outcome Test (SNOT-22) and the Lund-Kennedy endoscopic scores to evaluate the patients’ quality of life at baseline and at follow-up (mean ± standard deviation: 1.3 ± 0.3 and 8.8 ± 3.9  weeks postoperatively).

The results indicated that the postoperative SNOT-22 scores of the placebo group were noninferior to those in the antibiotic prophylaxis group. In addition, there were no significant differences between the placebo and antibiotic prophylaxis groups in LK score trajectories over time, or the postoperative infection rates (2.4% and 2.6%, respectively). The antibiotic group had a significantly higher rate of diarrhea (24.3%) than the placebo group (2.5%).

“Although statistically underpowered, the results suggest placebo was noninferior to prophylactic antibiotics after ESS for CRS regarding postoperative sinonasal‐specific QOL. There were no significant differences in postoperative endoscopic scores or rates of infection, but the rate of diarrhea was significantly higher in the antibiotic group,” the researchers concluded. “These findings add to the growing evidence that routine use of prophylactic postoperative antibiotics does not improve outcomes post‐ESS and significantly increases the rate of diarrhea.”

—Leigh Precopio

Reference:

Lehmann AE, Raquib AR, Siddiqui SH, et al. Prophylactic antibiotics after endoscopic sinus surgery for chronic rhinosinusitis: a randomized, double-blind, placebo-controlled noninferiority clinical trial. Int Forum Allergy Rhinol. Published online: December 19, 2020. doi: 10.1002/alr.22756