title: Endoscopic sinus surgery reduces antibiotic utilization in rhinosinusitis.
abstract: BACKGROUND
  Antibiotics are a mainstay of treatment for chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis(RARS). Although quality-of-life outcomes following endoscopic sinus surgery (ESS) have been studied, the change in antibiotic utilization following ESS is less wellknown.
  
  
  OBJECTIVE
  We aimed to determine the effect of ESS on antibiotic utilization in CRS and RARS.
  
  
  METHODS
  A multi-institutional, prospective cohort of patients with CRS and RARS was enrolled between January 2001 and January 2009. Patients completed the medication subscale of the Chronic Sinusitis Survey (CSS), and the Wilcoxon signed-rank test was used to compare differences in the overall reported time of antibiotic between preoperative and postoperative time points.
  
  
  RESULTS
  A total of 503 patients were followed for an average 17.3 months. Overall, patients reported a 57.2% reduction in time on antibiotics following ESS. The majority of patients (60.4%) reported significantly less antibiotic utilization after ESS (p < 0.001) consisting of an 83.7% reduction in the time on antibiotics. Subgroup analysis also revealed a significant reduction in antibiotic utilization for patients with and without nasal polyposis (59.0% and 58.2%; both p < 0.001) as well as RARS (61.2%; p = 0.001).
  
  
  CONCLUSIONS
  ESS significantly reduces antibiotic utilization for CRS and RARS. This finding demonstrates potential for lower health care expenditures related to antibiotics, as well as reduced risk of both antibiotic related morbidity and development of bacterial resistance.
authors.affiliation: Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, OR, USA.
authors.forename: Naveen D
authors.initials: ND
authors.lastname: Bhandarkar
authors.forename: Jess C
authors.initials: JC
authors.lastname: Mace
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000601:surgery; D011182:Postoperative Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012008:Recurrence; D012220:Rhinitis / Q000188:drug therapy / Q000601:surgery*; D012852:Sinusitis / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents