title: Long-term low-dose antibiotics in recalcitrant chronic rhinosinusitis: a retrospective analysis.
abstract: BACKGROUND
  In recalcitrant Chronic RhinoSinusitis (CRS) treatment with intranasal corticosteroids, short-term antibiotics and even sinus surgery is frequently insufficient. Long-term low-dose administration of antibiotics has been suggested as a treatment option in these patients. We analysed the outpatient clinic population treated with different long-term low-dose antibiotics at the AMC Amsterdam.
  
  
  METHODS
  Eligible patients, who were treated with trimethoprim-sulfamethoxazole or macrolides, were retrospectively identified from our outpatient clinic in 2009. The two main outcome measures were sinonasal complaints and nasal endoscopic findings. A 5-point grading scale was used to score the results compared with the pre-treatment situation. This was measured at several time-points during, and after the antibiotic course, and at the end of the follow-up term.
  
  
  RESULTS
  Seventy-six patients were included, 53 per cent had asthma and all of them had undergone sinus surgery. Seventy-eight per cent showed improvement of the symptoms, and 84 per cent demonstrated improvement of the sinonasal mucosa at the end of the course. No significant difference was found between the trimethoprim-sulfamethoxazole and macrolide group.
  
  
  CONCLUSIONS
  Long-term low-dose treatment with antibiotics seems to improve CRS symptoms and the appearance of the sinonasal mucosa on nasal endoscopy. However, at this stage, strong conclusions are immature because no placebo-group has been included. Despite increasing use of long-term low-dose treatment of recalcitrant CRS in referral centres, hard clinical evidence is lacking. More research is urgently required.
authors.affiliation: Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: W J M
authors.initials: WJ
authors.lastname: Videler
authors.forename: K
authors.initials: K
authors.lastname: van Hee
authors.forename: S M
authors.initials: SM
authors.lastname: Reinartz
authors.forename: C
authors.initials: C
authors.lastname: Georgalas
authors.forename: F W
authors.initials: FW
authors.lastname: van der Meulen
authors.forename: W J
authors.initials: WJ
authors.lastname: Fokkens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002908:Chronic Disease; D005260:Female; D006801:Humans; D018942:Macrolides / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012220:Rhinitis / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D015662:Trimethoprim, Sulfamethoxazole Drug Combination