Radiographic resolution of chronic rhinosinusitis without polyposis after 6 weeks vs 3 weeks of oral antibiotics.
BACKGROUND
Maximal medical therapy is poorly defined in chronic sinusitis treatment.


OBJECTIVE
To objectively evaluate the radiographic response of chronic rhinosinusitis without polyposis after 3 and 6 weeks of oral antibiotics.


METHODS
Thirty-five patients with confirmed chronic sinusitis without polyposis (disease apparent on initial computed tomography [CT] with appropriate symptom duration) were prescribed 6 weeks of antibiotics. When possible, culture-directed antibiotics were used; otherwise clindamycin was used empirically. A CT was performed after 3 and 6 weeks of therapy. CTs were then graded by the Lund-Mackay system. Demographic data were reviewed.


RESULTS
Of the 35 patients, 16 underwent all 3 CT scans and completed all 6 weeks of antibiotics. Three patients completed only 3 weeks of antibiotics, and 16 did not undergo the interval 3-week CT. Six patients (38%) had statistically significant improvement in their CT scans between weeks 3 and 6. In this subset of patients who improved, 37% of their overall radiographic improvement occurred in the 3- to 6-week treatment interval. No prognostic variables predicted which patients would radiographically improve after 3 weeks of antibiotics.


CONCLUSIONS
Some patients achieve radiographic improvement and disease resolution after the completion of a 3-week course of antibiotics. Therefore, maximal medical therapy for chronic sinusitis may consist of longer than 3 weeks of therapy to ensure maximal benefit.
Dubin
Marc G
MG
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. marc_dubin@comcast.net
Kuhn
Frederick A
FA
Melroy
Christopher T
CT
D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps; D012189:Retrospective Studies; D012220:Rhinitis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D012852:Sinusitis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents