title: Efficacy of targeted middle meatal antibiotics and endoscopic sinus surgery.
abstract: BACKGROUND
  Postoperative infection remains a significant comorbidity of endoscopic sinus surgery (ESS) delayed healing, synechia formation, etc. The objective of this study was to compare the incidence of postoperative infection after ESS in patients receiving conventional postoperative oral antibiotic prophylaxis versus a synthetic bioabsorbable antibiotic-soaked nasal sponge used in the middle meatus (MM) in lieu of oral antibiotics.
  
  
  METHODS
  A prospective randomized multicenter trial included 321 chronic rhinosinusitis patients undergoing minimally invasive ESS who received either 1 week of oral antibiotics and a saline-soaked bioabsorbable MM sponge (control group) or no oral antibiotics and the placement of a bacitracin-soaked bioabsorbable sponge in the MM (study group). Evaluations performed at baseline, 3-weeks, and 3-months postoperatively included the 20-item Sino-Nasal Outcome Test and nasal endoscopic examination.
  
  
  RESULTS
  The 3-week postoperative infection rate was not significantly different between the study (n = 165) and control groups (n = 156): 5.4% versus 3.8%; p > 0.05. In addition, there was no significant difference between the two patient groups on evaluation of MM granulations, synechia, middle turbinate lateralization, or sponge retention.
  
  
  CONCLUSIONS
  Antibiotic-soaked synthetic bioabsorbable MM sponges show equivalent efficacy in controlling post ESS infections compared with conventional postoperative oral antibiotics. Topical antibiotic delivery to the MM via bioabsorbable sponges may reduce the need for postoperative systemic antibiotics and provide a cost-effective alternative that eliminates the issues of antibiotic side effects, drug-drug interactions, and medication compliance in the postoperative setting.
authors.affiliation: St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA.
authors.forename: Rohan C
authors.initials: RC
authors.lastname: Wijewickrama
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Catalano
authors.forename: Rahul
authors.initials: R
authors.lastname: Gupta
authors.forename: Seth N
authors.initials: SN
authors.lastname: Willen
authors.forename: Yogesh
authors.initials: Y
authors.lastname: More
authors.forename: Sashikanth
authors.initials: S
authors.lastname: Jonnalagadda
authors.forename: Meir
authors.initials: M
authors.lastname: Warman
mesh_terms: D000281:Administration, Intranasal / Q000379:methods*; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001900:Boston; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059747:Nasal Surgical Procedures / Q000009:adverse effects*; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D011446:Prospective Studies; D012220:Rhinitis / Q000473:pathology / Q000601:surgery*; D012852:Sinusitis / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology*; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents