title: Intravenous antibiotics for refractory rhinosinusitis in nonsurgical patients: preliminary findings of a prospective study.
abstract: BACKGROUND
  Some patients with persistent chronic sinusitis have either had unsuccessful surgery or have simply refused surgery. In nonsurgical candidates, when oral antibiotics and traditional therapy are unsuccessful, home intravenous (i.v.) antibiotics present an effective alternative.
  
  
  METHODS
  Forty-five patients were assessed before treatment using a semiquantitative scoring system and visual analog scales to measure major and minor symptoms of rhinosinusitis. Computed tomography (CT) scans were assessed using the Lund-MacKay staging system; nasal endoscopic findings were documented. Seven patients had nasal endoscopy and CT results. Medical diseases known to be associated with rhinosinusitis were documented. Endoscopic-guided culture and sensitivities were obtained. After successful insertion and radiological placement confirmation, home i.v. antibiotics were administered via a peripherally inserted central catheter line. Antibiotic choice was based on the culture and sensitivity reports. Treatment continued for 6 weeks; subsequent cultures were obtained at weeks 3, 6, and 9. Nasal endoscopy was performed, and rhinosinusitis symptoms were assessed at weeks 3, 6, and 9. Follow-up CT scans were obtained at week 12 in a subset of patients.
  
  
  RESULTS
  Significant improvement in symptom analysis was seen in patients receiving home i.v. antibiotics when previous oral antibiotic treatment and/or surgery had failed.
  
  
  CONCLUSIONS
  Home i.v. antibiotics provide an excellent alternative to surgery for patients who have either had unsuccessful surgery or who have refused surgery.
authors.affiliation: New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Vijay
authors.initials: V
authors.lastname: Anand
authors.forename: Howard
authors.initials: H
authors.lastname: Levine
authors.forename: Michael
authors.initials: M
authors.lastname: Friedman
authors.forename: Yosef
authors.initials: Y
authors.lastname: Krespi
authors.forename: William
authors.initials: W
authors.lastname: Panje
authors.forename: Raymond
authors.initials: R
authors.lastname: Schettino
authors.forename: James
authors.initials: J
authors.lastname: Stankiewicz
authors.forename: Wellington
authors.initials: W
authors.lastname: Tichenor
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Kacker
authors.forename: Corinne
authors.initials: C
authors.lastname: Horn
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D004724:Endoscopy; D018718:Home Infusion Therapy; D006801:Humans; D007262:Infusions, Intravenous; D012220:Rhinitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents