Intravenous antibiotics for refractory rhinosinusitis in nonsurgical patients: preliminary findings of a prospective study.
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.
Anand
Vijay
V
New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
Levine
Howard
H
Friedman
Michael
M
Krespi
Yosef
Y
Panje
William
W
Schettino
Raymond
R
Stankiewicz
James
J
Tichenor
Wellington
W
Kacker
Ashutosh
A
Horn
Corinne
C
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
D000900:Anti-Bacterial Agents