The use of antibiotics in chronic rhinosinusitis (CRS) has been established as part of the EPOS guidelines, as has the role of taking swabs for microbiology culture. There has not been much literature however on whether tailoring antibiotics in response to culture and sensitivity has an impact on patient reported outcomes. In this retrospective study, the authors reviewed 105 adults with CRS who had nasal swabs taken using an endoscopic assisted technique. SNOT-20 outcomes were recorded. Mean age was 46.3, with mean 1.9 endoscopic sinus surgical procedures each (0-8). Empirical antibiotic therapy was commenced in 55 cases, most commonly using Co-Amoxiclav (21), quinolones (14) and clarithromycin (12). The most common pathogens grown from culture were S.aureus (29%), P.aeruginosa (24%) and MRSA (11%) Antibiotic therapy was changed in 81 patients in response to culture results, with Doxycycline, Quinolones or Trimethoprim initiated most commonly. Mean duration of therapy was 2-3 weeks. SNOT-20 outcomes were recorded pre- and post-treatment. Statistically significant change in total SNOT-20 scores and all four subdomains was noted, with improvement being clinically meaningful in the rhinologic subdomain (− 1.10, p < 0.0001). Repeat purulence was only noted in five cases (4.8%). Multivariate regression analysis demonstrated that concurrent use of oral steroids was independently associated with improvement in the rhinologic subdomain (p = 0.0041). This study highlights that empiric prescribing of antibiotics may be sub-optimal and not in keeping with maximal medical therapy. Clinicians should therefore consider taking culture swabs as part of their routine practice to guide antibiotic therapy.
Patient reported outcomes improve if antibiotic choice is directed from endoscopic culture results in chronic rhinosinusitis
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